Potential Role of Latent Tuberculosis Infection in the Pathophysiology of Cardiovascular Disease

To the Editor—We read with interest the publication by Huaman et al showing that latent tuberculosis infection (LTBI) was associated with an increased odds of subclinical coronary atherosclerosis in Peru and Uganda [1]. These finding raise further questions on the potential role of LTBI in the pathophysiology of cardiovascular disease (CVD). Here we discuss some key statistical concerns and their implications on interpreting the reported results. For simplicity, we refer to a regression model with 3 variables: outcome variable Y, independent variable X1, and independent variable X2. If either X1 or X2 is positively correlated with Y and X1 is also positively correlated with X2, the magnitude of an observed association between Y and X1 will decrease after adjusting for X2 [2]. For example, smokers are more likely to drink alcohol, and either smoking or drinking increases the risk of lung cancer. Therefore, the magnitude...