Cardiovascular Morbidity and Mortality Among People Diagnosed with Tuberculosis: A Systematic Review and Meta-Analysis

Abstract

Background: Emerging evidence of increased disease risk among people diagnosed with appears to indicate risk assessment among people diagnosed with TB; however, no synthesis of the epidemiological evidence of disease among people diagnosed with TB exists. We hypothesized elevated risk of morbidity and mortality among people diagnosed with active or latent tuberculosis. Methods: We conducted a systematic review and meta-analysis. EMBASE, MEDLINE, and Cochrane databases were searched (inception to June 2018) for terms related to tuberculosis and cardiovascular diseases. Inclusion criteria: trial, cohort, or case-control study design; patient population that includes people diagnosed with TB infection or disease; relative risk (RR) estimate and confidence interval reported for morbidity or mortality compared to suitable controls. Exclusions: TB definition not provided; outcome definition not provided; duplicate study; no English abstract; non-human participants. Two reviewers screened studies, applied ROBINS-I tool to assess risk of bias, and extracted data independently. Random effects meta-analysis estimated a pooled RR of morbidity and mortality. PROSPERO (CRD42018100498). Findings: 5,628 articles were identified, 211 full texts were reviewed, and 15 included. We estimated a per-protocol meta-analysis pooled RR of 2·06 (95% CI 1·58-2·68) for morbidity and mortality among those diagnosed with TB (p<0.0001). A 'Serious' pooled risk of bias was found across studies. High between-study heterogeneity was found (I2 = 95%). Interpretation: Systematic risk assessment among patients may be warranted. Prospective studies are needed to understand the relationship between and disease. Clinical Registration Number: The study was prospectively registered in PROSPERO (CRD42018100498). Funding: JCJ is funded by a Michael Smith Foundation Scholar Award and the Canadian Institutes for Health Research. Declaration of Interests: The authors declare that they have no conflicts. Ethical Approval Statement: Not required.