Shingles Infection Associated With Elevated Long-term Risk of Cardiovascular Events

Data indicates that in the United States, almost all individuals at least 50 years of age have been infected with the varicella zoster virus (VZV) and, consequently, are at risk for developing herpes zoster (HZ), commonly known as “shingles.” The Centers for Disease Control and Prevention (CDC) indicate an estimated 1 in 3 individuals in the United States will develop shingles in their lifetime.¹

As the aging population, the number of individuals with conditions that compromise the immune system, and the number of those taking immunosuppressive agents continue to expand, the number of those at risk for shingles will likely increase as well. According to a 2021 CDC publication, in 2019, 26.1% of adults at least 50 years of age had ever received a shingles vaccination.²

In a recent study conducted at the Brigham and Women’s Hospital, a founding member of the Mass General Brigham health care system, researchers sought to examine the association between shingles and long-term risk of  stroke or coronary heart disease (CHD) among 3 large US cohorts involving more than 200,000 individuals.^3,4 According to the researchers, a growing body of evidence suggests VZV‐related vasculopathy plays a role in the development of cardiovascular disorders, including stroke and CHD.

Individuals who participated in the study had no prior history of stroke or CHD. Using questionnaires collected once every 2 years for up to 16 years, researchers studied the incidence of shingles, stroke, and CHD and confirmed patients’ diagnoses by reviewing medical records. The researchers defined the incidence of stroke and coronary heart disease as having a non-fatal or fatal myocardial infarction or a coronary revascularization procedure (CABG, coronary artery bypass graft or percutaneous transluminal coronary angioplasty). An additional endpoint was a combined outcome of cardiovascular disease, which included either stroke or CHD, whichever came first.

The results, which were published in the Journal of the American Heart Association,³ revealed shingles is associated with an almost 30% higher long-term risk of a major cardiovascular event. This augmented risk may persist for 12 years or more after a person develops shingles, and risk may be greater among those with potentially immunocompromising conditions or who are taking immunosuppressive treatments. The authors said their findings imply long‐term implications of HZ and emphasize the significance of public health efforts for prevention.

In a statement,⁴ lead author Sharon Curhan, MD, ScM, a physician and epidemiologist in the Channing Division of Network Medicine at Brigham and Women's Hospital, said, “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.”

The researchers also noted they are currently gathering vaccination information among their participants and hope to conduct further studies in the future.

Conclusion

Shingles can be associated with painful and debilitating postherpetic neuralgia, and some individuals experience long-term complications as a result. The findings from this new study provide more clinical evidence that should encourage eligible individuals to adhere to the CDC’s recommendation for the 2-dose series of the shingles vaccine. The authors of the study indicated the availability of a safe and effective vaccine provides an opportunity to diminish the burden of shingles and lessen the risk of subsequent cardiovascular complications.

In my conversations with several health care providers across various settings, some have expressed that many of their patients are unaware of the recommendations for shingles vaccination. It is critical to continue to expand education initiatives and awareness about the benefits associated with vaccination against shingles, in order to provide patients with information that will enable them to make informed decisions about their health and reduce and/or prevent complications associated with a shingles infection.

References:

1. Centers for Disease Control and Prevention. Shingles Burden and Trends. Reviewed August 14, 2019. Accessed December 9, 2022. https://www.cdc.gov/shingles/surveillance.html  
2. Centers for Disease Control and Prevention. Quick Stats: Percentage of Adults Aged ≥50 Years Who Ever Received a Shingles Vaccination, by Race and Hispanic Origin and Sex — National Health Interview Survey, United States, 2019. MMWR Morb Mortal Wkly Rep. 2021;70:901. doi:10.15585/mmwr.mm7024a5
3. Curhan SG, Kawai K, Yawn B, Rexrode KM, Rimm EB, Curhan GC. Herpes zoster and long‐term risk of cardiovascular disease. J Am Heart Assoc. 2022;11:e027451. doi:10.1161/JAHA.122.027451
4. Shingles associated with increased risk for stroke, heart attack. News release. Brigham and Women’s Hospital, ScienceDaily; November 22, 2022. Accessed December 9, 2022. www.sciencedaily.com/releases/2022/11/221122125302.htm