Herpes zoster is associated with a higher long-term risk of developing major cardiovascular diseases



A new study by investigators from Brigham and Women’s Hospital, a founding member of Brigham and Women’s Comprehensive Healthcare System, shows that shingles, also known as herpes zoster, is associated with an approximately 30% higher long-term risk of a major cardiovascular event such as a stroke or stroke. Heart attack. Their results are published in Journal of the American Heart Association.

Our findings indicate that there are long-term effects of shingles and highlight the importance of public health efforts for prevention. Given the growing number of Americans at risk of this painful and often disabling disease and the availability of an effective vaccine, the herpes zoster vaccine can provide a valuable opportunity to reduce the burden of shingles and reduce the risk of subsequent cardiovascular complications.”


Sharon Korhan, MD, ScM, lead author and physician and epidemiologist in the Channing Division of Network Medicine at Brigham and Women’s Hospital

Shingles often causes a painful rash and can occur anywhere on the head or body. Herpes zoster is caused by the varicella zoster virus, which is the same virus that causes it Chickenpox. After a person has chickenpox, the virus remains in their body for the rest of their lives. Years and even decades later, the virus may reactivate as shingles. Almost all individuals 50 years of age or older in the United States have been infected with the chickenpox virus and are therefore at risk for herpes zoster.

Approximately 1 in 3 people will develop shingles in their lifetime, with more cases to be expected as people age and more people become immunocompromised due to the disease or use of medications.

The most common complication of shingles is postherpetic neuralgia. This condition affects nerve fibers and skin, causing a burning pain that lingers long after the rash and shingles blisters have disappeared. However, a growing body of evidence suggests that virus reactivation may have long-term side effects. The virus may play a role in the development of cardiovascular disorders, including stroke and coronary artery disease. The virus has been detected in blood vessels large and small, which can cause infections over time as well as chronic changes in blood vessels. These changes can increase the risk of blockages in blood vessels, restricted blood flow, and cardiovascular events such as strokes and heart attacks.

The prospective longitudinal study followed three large US cohorts of more than 200,000 women and men: the Nurses’ Health Study (~79,000 women), the Nurses’ Health Study 2 (~94,000 women) and the Health Professionals Follow-up Study (~31,000 men). The participants had no prior history of stroke or coronary heart disease. The team collected information on shingles, stroke, and coronary heart disease using questionnaires collected every two years and confirmed the diagnoses by reviewing the medical history. The team followed the participants for up to 16 years and assessed whether those who developed shingles were at increased risk of stroke or coronary heart disease years after an episode of shingles.

The researchers tracked cases of stroke, coronary heart disease – defined as having a nonfatal or fatal myocardial infarction (heart attack) or a coronary angioplasty procedure (coronary artery bypass grafting, coronary artery bypass grafting or percutaneous coronary angioplasty) . The researchers also assessed a combined cardiovascular disease outcome, which included either stroke or coronary heart disease, whichever came first.

The results showed that people who had previously had shingles had a 30% higher long-term risk of major cardiovascular disease than those who did not have shingles, and the elevated risk may persist for 12 years or longer after infection with shingles.

Because of the timing, much of the study has been done in the lead-up to herpes zoster vaccines becoming widely available. Even after its introduction, vaccination uptake was generally low. Because of these limitations, the researchers were unable to assess whether vaccination status might influence the association of shingles and long-term risk of a major cardiovascular event.

As more people choose to receive the herpes zoster vaccine, future studies could examine whether vaccination affects the relationship of shingles and risk of cardiovascular disease. “We are currently collecting vaccination information among our participants and hope to conduct these studies in the future,” Korhan adds.

source:

Journal reference:

Korhan, Saint-Germain, et al. (2022) Herpes zoster and long-term risk of cardiovascular disease. Journal of the American Heart Association. doi.org/10.1161/JAHA.122.027451.



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