Published December 16, 2022
Shingles Linked to Higher Risk of Cardiovascular Events
Boston—A new study offers a compelling reason for pharmacists to urge those who are eligible to get herpes zoster (HZ) vaccination. The researchers found a 30% increased risk of a major cardiovascular event in those who have had shingles.
Researchers from Brigham and Women’s Hospital in Boston and colleagues found that the elevated risk might last for 12 years after infection and that the risk is highest among patients with potentially immunocompromising conditions or who are taking immunosuppressing treatments.
Findings of the large study involving 200,000 participants were published in the Journal of the American Heart Association.
“Our findings suggest there are long-term implications of shingles and highlight the importance of public health efforts for prevention,” said lead author Sharon Curhan, MD, ScM, a physician and epidemiologist at Brigham and Women’s Hospital. “Given the growing number of Americans at risk for this painful and often disabling disease and the availability of an effective vaccine, shingles vaccination could provide a valuable opportunity to reduce the burden of shingles and reduce the risk of subsequent cardiovascular complications.”
Shingles, which often causes a painful rash is caused by the varicella zoster virus, the same virus that causes chickenpox and becomes reactivated. After a person has chickenpox, the virus stays in their body for the rest of their life. The infection affects about one in three people in their lifetime, especially among older people and those with compromised immunity.
Previously, postherpetic neuralgia, which can cause burning pain lasting after the rash and blisters disappear, was considered one of the most serious complications of shingles. That is still the case, but the new study adds the risk of cardiovascular disease as another significant risk.
The research team investigated the longitudinal association of HZ, commonly known as shingles, and long-term risk of stroke or coronary heart disease (CHD) among participants in three large U.S. cohorts, the NHS (Nurses’ Health Study), NHS II (Nurses’ Health Study II), and HPFS (Health Professionals Follow-Up Study).
Participating were 79,658 women in the NHS (2000-2016), 93,932 women in the NHS II (2001-2017), and 31,440 men in the HPFS (2004-2016); none of them had a prior stroke or been diagnosed with CHD. Medical record review and questionnaires were used to obtain information on HZ, stroke, and CHD.
The authors reported that during more than 2 million person-years of follow-up, 3,603 incident stroke and 8,620 incident CHD cases were documented. “History of HZ was significantly and independently associated with higher long-term risk of stroke and CHD,” they advised.
In pooled analyses, compared with those never diagnosed with HZ, the multivariable-adjusted hazard ratios (95% CIs) for stroke were:
• 1.05 (0.88-1.25) among those with 1 to 4 years since HZ
• 1.38 (1.10-1.74) among those with 5 to 8 years since HZ
• 1.28 (1.03-1.59) among those with for 9 to 12 years since HZ
• 1.19 (0.90-1.56) among those with ≥13 years since HZ.
For CHD, the corresponding multivariable-adjusted hazard ratios (95% CIs) were 1.13 (1.01-1.27) for 1 to 4 years, 1.16 (1.02-1.32) for 5 to 8 years, 1.25 (1.07-1.46) for 9 to 12 years, and 1.00 (0.83-1.21) for ≥13 years.
“HZ is associated with higher long-term risk of a major cardiovascular event,” the researchers pointed out. “These findings suggest there are long-term implications of HZ and underscore the importance of prevention.”
Part of the explanation, according to the report, is that the virus has been detected in large and small blood vessels, which can cause inflammation and chronic vascular changes over time.
Most of the study took place in the period before shingles vaccines became widely available and—even after their introduction—vaccine uptake has remained relatively low. While the study was not able to document the effects of vaccination on CVD risks.
However, the assumption is that preventing HZ would also prevent the longer-term side effects. “We are currently collecting vaccination information among our participants and hope to conduct these studies in the future,” Dr. Curhan added.
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