Exploring the Connection Between Tuberculosis and Cardiovascular Disease with Dr. Matthew Magee
For Matthew Magee, Associate Professor, Department of Epidemiology, Hubert Department of Global Health understanding tuberculosis (TB) means looking beyond the infection itself to examine how the disease may shape a person’s health long after diagnosis.
An Emory researcher whose work focuses on the intersection of tuberculosis and noncommunicable diseases, Magee’s research consists of analyzing the complex, bidirectional relationships between TB and cardiometabolic conditions, including diabetes and cardiovascular disease.
“At Georgia State, I was one of maybe the only ones working on TB,” Magee explains. “Here at Emory, there’s a large group of core faculty members who spend almost their entire time on TB.”
That collaborative environment has allowed Magee to continue investigating an increasingly important question: What happens when an infectious disease like TB intersects with chronic conditions such as cardiovascular disease and diabetes?
From Global Health Experience to TB Research
Magee’s interest in tuberculosis began while studying for a master’s degree and working in public health in India. Although the initial work focused on hepatitis C, the experience highlighted the significant burden of TB and its intersection with other health conditions.
“I learned more and more about the importance of TB on a global scale,” Magee says. “India also has lots of cardiovascular and metabolic diseases, so I think witnessing and working with people who had comorbidities with TB and other diseases was the motivation.”
Tuberculosis is a bacterial infection that most commonly affects the lungs. A person can have TB infection without symptoms when the immune system keeps the bacteria under control, while some people eventually develop active TB disease. Pulmonary TB can cause symptoms including persistent cough, weight loss, night sweats, body aches and, in some cases, coughing up blood.
While TB is curable, treatment for active disease generally requires multiple antibiotics for four to six months and can take longer for drug-resistant forms of the disease.
Connecting Tuberculosis and Cardiovascular Disease
In a recent study, Magee and colleagues examined whether tuberculosis contributes to an increased incidence of cardiovascular disease.
Previous research has suggested that people who have TB face a higher risk of cardiovascular disease. This study allowed researchers to investigate that relationship in greater detail by examining participants both before and after their TB diagnosis.
Using medical record data from the United States and United Kingdom, the researchers were able to examine whether similar patterns emerged across two different populations and health systems.
The results revealed a significant association.
“We saw a threefold increased risk of developing major cardiovascular events in people with TB compared to well-characterized and matched controls,” Magee says.
Importantly, researchers found that the increased incidence of cardiovascular events occurred particularly close to the time of TB diagnosis.
Understanding Why the Risk Increases
The study establishes an important relationship between TB and cardiovascular events, but another major question remains: Why does this happen?
Because the research was an epidemiologic study based primarily on medical records, it was not designed to pinpoint the biological mechanisms responsible for the increased cardiovascular risk.
One hypothesis is that chronic inflammation associated with TB infection may contribute to changes that affect cardiovascular health. Researchers are now interested in investigating those mechanisms more closely.
The potentially prolonged nature of TB makes that question particularly important. Some individuals may live with the disease for an extended period before completing diagnosis and treatment, potentially exposing the body to longer periods of inflammation.
What Could This Mean for Clinical Care?
For clinicians, the findings provide another reason to consider the broader health of patients diagnosed with TB.
“At this point, [the message] is just to be aware that people with TB are at increased risk of this event,” Magee says.
However, the study does not yet establish exactly how clinicians should intervene to reduce that risk. Questions remain about whether certain patients with TB could benefit from additional cardiovascular risk-reduction strategies, such as statin therapy, and when those interventions would be most effective.
“What should be done in terms of intervening to prevent [cardiovascular events] at this point—that’s what we don’t know,” Magee explains.
Magee says answering those questions could ultimately help move the research from identifying an association toward developing strategies that protect cardiovascular health among people with TB.
Looking Beyond the Association
Magee is already looking toward the next phase of the research.
A proposed prospective study would follow participants around the time of TB diagnosis and another group several years after completing TB treatment. Unlike the retrospective study, researchers would enroll and follow participants directly, allowing them to conduct cardiovascular imaging and collect more detailed measurements over time.
The goal is to better understand when cardiovascular changes occur, how long elevated risk persists and what mechanisms may be driving those changes.
One cohort would be followed for approximately 18 months, while another would include people who completed TB treatment several years earlier. This approach could help researchers determine whether cardiovascular risk is concentrated around active TB disease or continues years after treatment.
For Magee, these questions are part of a broader effort to understand diseases not in isolation, but as interconnected conditions that can influence one another throughout a person’s life.
By examining the relationship between infectious diseases such as tuberculosis and chronic conditions including diabetes and cardiovascular disease, Magee’s research could help uncover new opportunities to identify risks earlier and ultimately improve long-term health outcomes.