title: Angiotensin-Converting Enzyme Inhibitors and Active Tuberculosis: A Population-Based Study.
abstract: Numerous epidemiological data suggest that the use of angiotensin-converting enzyme inhibitors (ACEis) can improve the clinical outcomes of pneumonia. Tuberculosis (TB) is an airborne bacteria like pneumonia, and we aimed to find out whether the use of ACEis can decrease the risk of active TB.We conducted a nested case-control analysis by using a 1 million longitudinally followed cohort, from Taiwan national health insurance research database. The rate ratios (RRs) for TB were estimated by conditional logistic regression, and adjusted using a TB-specific disease risk score (DRS) with 71 TB-related covariates.From January, 1997 to December, 2011, a total of 75,536 users of ACEis, and 7720 cases of new active TB were identified. Current use (DRS adjusted RR, 0.87 [95% CI, 0.78-0.97]), but not recent and past use of ACEis, was associated with a decrease in risk of active TB. Interestingly, it was found that chronic use (>90 days) of ACEis was associated with a further decrease in the risk of TB (aRR, 0.74, [95% CI, 0.66-0.83]). There was also a duration response effect, correlating decrease in TB risk with longer duration of ACEis use. The decrease in TB risk was also consistent across all patient subgroups (age, sex, heart failure, cerebrovascular diseases, myocardial infraction, renal diseases, and diabetes) and patients receiving other cardiovascular medicine.In this large population-based study, we found that subjects with recent and chronic use of ACEis were associated with decrease in TB risk.
authors.affiliation: From the Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung; Chang Gung University College of Medicine, Taoyuan (J-YW, S-CH); Department of Emergency Medicine, National Taiwan University Hospital (M-TGL, S-HL, C-CL); Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital (S-HL); Department of Medicine, College of Medicine, National Yang Ming University, Taipei (S-HL); Department of Family Medicine, Chang Gung Memorial Hospital; Chang Gung University College of Medicine (Y-WT, S-SC); Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan (S-SC); and Department of Emergency Medicine and Department of General Medicine, National Taiwan University Hospital Yun-lin Branch, Douliou (C-CL), Taiwan.
authors.forename: Jiunn-Yih
authors.initials: JY
authors.lastname: Wu
authors.forename: Meng-Tse Gabriel
authors.initials: MG
authors.lastname: Lee
authors.forename: Si-Huei
authors.initials: SH
authors.lastname: Lee
authors.forename: Shih-Hao
authors.initials: SH
authors.lastname: Lee
authors.forename: Yi-Wen
authors.initials: YW
authors.lastname: Tsai
authors.forename: Shou-Chien
authors.initials: SC
authors.lastname: Hsu
authors.forename: Shy-Shin
authors.initials: SS
authors.lastname: Chang
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Lee
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D056990:Post-Exposure Prophylaxis / Q000379:methods*; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors