Herpes Zoster Increases the Risk of Stroke and Myocardial Infarction

JACC: Journal of the American College of Cardiology

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• This large retrospective cohort study used a subset of data from the Korean National Health Insurance Database to evaluate characteristics of patients newly diagnosed with stroke, myocardial infarction (MI), and herpes zoster (HZ) who were representative of the general population. A propensity score–matched analysis was performed to assess whether HZ affected risk of stroke and MI using data extracted from the records of 519,880 patients observed from 2003 to 2013. The HZ group differed from the non-HZ group in several ways, including containing a higher proportion of females, having more frequent association with risk factors for MI, and having lower rates of smoking, among other factors. The standardized differences for these factors were all <10% after propensity score matching and adjustment. A composite value including stroke, MI, and a composite of cardiovascular events was higher in those diagnosed with HZ compared with the non-HZ group. Risk of MI and stroke was greatest within the first year following HZ diagnosis and then declined. Hazard ratios for stroke decreased with age from a peak in individuals <40 years of age. The increase in risk associated with HZ infection was 59%, 41%, and 35% for MI, composite of cardiovascular events, and stroke, respectively, in propensity score–matched analysis.

• These data suggest an important increase in the risk of cardiovascular events, stroke, and MI in patients with HZ, especially in the first year after infection and in younger patients lacking risk factors for atherosclerosis, suggesting a need for appropriate clinical monitoring of these patients.

 Cardiology

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Jacob A Udell MD, MPH, FRCPC

This study within the Korean National Health Insurance Database followed approximately 23,000 patients newly diagnosed with herpes zoster (HZ) between 2002 and 2013, representing 4% of the entire cohort under observation. After propensity matching, patients with recent HZ were at 1.41 times higher risk (95% CI, 1.25–1.59) for the composite endpoint of cardiovascular (CV) events, including stroke (HR, 1.35) and myocardial infarction alone (HR, 1.59) within the first year after the onset of HZ. The risk was highest in the youngest group of patients, under 40 years of age (a relatively younger population with fewer risk factors for atherosclerosis). The association between HZ with subsequent CV events may be related to direct or indirect mechanisms of viral inflammation or other vascular injury–induced plaque rupture. Alternatively, younger patients susceptible to HZ may share common factors for higher risk of CV events (ie, a systemic illness). Nevertheless, if these compelling data are replicated, it might suggest that a randomized trial of varicella zoster virus vaccination for cardioprotection is warranted, similar to ongoing trials studying effective influenza vaccination.