Assessment of Pharmacotherapy and Clinical Outcomes of Treatment for the Development of Cardiovascular Disease among Tuberculosis Patients

Background: Tuberculosis (TB) continues to impose a substantial morbidity and mortality burden globally, particularly in developing countries. Growing evidence suggests an epidemiological and pathological interplay between TB and cardiovascular disease (CVD). Beyond conventional cardiovascular risk factors such as diabetes mellitus, hypertension, and dyslipidemia, there are other factors, including chronic inflammation, immune activation, and metabolic disruption, that are caused by Mycobacterium tuberculosis and may also contribute to cardiovascular complications. Chronic immune activation involving monocytes, macrophages, lymphocytes, and cytokines, which are crucial for TB defense, may also contribute to atherogenesis and cardiovascular dysfunction. Objective: The main objective of this study was to evaluate anti-tuberculosis pharmacotherapy patterns and clinical outcomes among patients without cardiovascular disease (CVD). Methodology: This retrospective cohort study with an observational analytic design, was conducted at Penang General Hospital, Malaysia, from January 2023 to August 2023 using medical records from January 2015 to December 2022, evaluated 402 TB patients without pre-existing CVD. The study assessed the association between anti-tuberculosis pharmacotherapy patterns, adverse drug reactions, drug-resistant TB, clinical treatment outcomes, and the development of CVD during TB therapy using chi-square tests. Results: The predominant anti-tuberculosis regimen was 2HRZE/4HR, commonly administered as fixed-dose combinations. Adverse drug reactions were observed, including transaminitis (8.3%), skin rashes (6.3%), nausea/vomiting (4.7%), hyperbilirubinemia (4.2%), blurred vision (2.3%), thrombocytopenia (2.1%), and drug-induced hepatitis (2.6%). Drug-resistant TB constituted 6.5% of cases, comprising mono-drug resistance (3.4%), MDR-TB (1.4%), and poly-drug resistance (0.9%). Regarding clinical outcomes, 41.5% of patients were cured, 21.9% completed treatment, 15.2% died, and 5.5% were lost to follow-up, with a treatment failure rate of 0.7%. A significant association was found between the type of TB case and clinical outcomes (χ² = 15.826, p < 0.05). New TB cases showed higher cure and completion rates. Cardiovascular disease developed in 41 patients and was associated with markedly increased mortality (28/41) and significantly poorer treatment outcomes (p < 0.001). Comorbidities, including diabetes mellitus (χ² = 14.720, p = 0.012), HIV infection (χ² = 28.727, p = 0.001), acute kidney injury (χ² = 22.156, p < 0.001), and anaemia (χ² = 16.872, p = 0.005), were significantly linked to adverse clinical outcomes. Conclusions: TB patients who developed cardiovascular disease exhibited significantly higher mortality and reduced treatment success. Comorbidities such as diabetes, HIV, acute kidney injury, and anaemia further compromised clinical outcomes. These findings highlight the need for routine cardiovascular risk assessment during TB therapy. Early identification of high-risk patients and integrated, multidisciplinary management approaches are essential. Strengthening combined care for infectious and non-communicable diseases may improve survival in resource-limited settings.