Herpes zoster increased risk for stroke, TIA, MI in young people
Herpes zoster is an independent risk factor for stroke, transient ischemic attack and MI in people whose cases occurred when they were younger than 40 years, according to recent study findings.
Researchers performed a retrospective cohort study to determine whether herpes zoster was a risk factor for stroke, TIA and MI. Stroke and TIA are known to be complications of acute herpes zoster.
Using a UK primary care database, Judith Breuer, MD, and colleagues analyzed 106,601 people with herpes zoster and 213,202 controls matched for age, sex and general practice. All participants were followed for a median of 6.3 years (range, 1 year to 23.7 years). Cases and matched controls were assessed for incident stroke, TIA or MI after the index date. The researchers adjusted for risk factors, including atrial fibrillation, BMI >30, carotid stenosis, cholesterol >6.2 mmol/L, diabetes, hypertension, intermittent arterial claudication, ischemic heart disease, smoking and valvular heart disease.
Patients with herpes zoster had an increased risk for MI (HR=1.1; 95% CI, 1.05-1.16) and TIA (HR=1.15; 95% CI, 1.09-1.21) compared with matched controls, but not stroke (HR=1.02; 95% CI, 0.98-1.07). However, those whose cases of herpes zoster occurred before age 40 years had elevated risk for stroke (HR=2.42; 95% CI, 1.34-4.36), TIA (HR=1.49; 95% CI, 1.04-2.15) and MI (HR=1.74; 95% CI, 1.13-2.66) compared with matched controls.
The researchers also found that patients younger than 40 years were less likely to be asked about CV risk factors by their doctors compared with older patients (P<.001). Breuer, of University College London, and colleagues wrote that stroke incidence in the UK has declined by more than 30% in the past 10 years in part because of government initiatives encouraging screening and treatment of vascular risk factors in those aged at least 45 years, but it has not changed among those aged 45 years and younger.
“These results support a significant role for [the varicella-zoster virus], independently of other vascular risk factors, in the pathogenesis of stroke and cerebrovascular disease in the UK population, particularly at younger ages,” Breuer and colleagues wrote. “… Immunization with the licensed zoster vaccine has been shown to significantly reduce the incidence of [herpes zoster], as well as significantly decrease the severity of neuropathic complications.”
They added that more research is required to better understand the pathogenesis of herpes zoster among those with risk factors for vascular disease and whether herpes zoster immunization programs would reduce the incidence of vascular events. In the meantime, the researchers wrote, the vaccine should be offered to those with vascular disease risk factors, and screening for these risk factors should be encouraged among those with herpes zoster.
Disclosure: The study was funded by an unrestricted investigator grant from Sanofi-Pasteur MSD. Breuer reports financial ties with GlaxoSmithKline and Sanofi-Pasteur MSD.