Key clinical point: Herpes zoster is associated with significantly increased short-term risk of stroke/TIA.
Major finding: Adults aged 18-49 years were threefold more likely than controls to experience stroke or TIA within a month of herpes zoster diagnosis.
Study details: This retrospective study included 23,339 U.S. adults with herpes zoster and twice as many matched controls.
Disclosures: The study was sponsored by GlaxoSmithKline and presented by a GSK employee.
Source: Rausch DA. ACC 18
ORLANDO – The risk of stroke and TIA – but not of acute MI – is significantly increased during the period surrounding diagnosis of herpes zoster, compared with the rate in matched zoster-free controls, according to a retrospective study of nearly 70,000 U.S. adults. A particularly striking study finding was the marked age disparity in the magnitude of vascular event risk associated with herpes zoster (HZ), with younger adults being at higher risk.
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The incidence rate ratio for the composite vascular-event endpoint consisting of acute MI, stroke, or TIA during the period from 1 month before HZ diagnosis to 1 month after was threefold higher in adults aged 18-49 years, compared with matched adults without shingles, while in adults aged 50 years or older, the incidence rate ratio was 1.2, Deborah A. Rausch, MD, reported at the annual meeting of the American College of Cardiology.
This increased vascular event risk associated with HZ was transitory. During the entire study follow-up period, which stretched from 1 month prior to HZ diagnosis to 12 months afterward, there was no overall increased vascular event risk associated with HZ, noted Dr. Rausch, an infectious diseases specialist who serves as director of clinical and medical affairs for the U.S. zoster program at GlaxoSmithKline in Philadelphia.
She presented a retrospective cohort study of U.S. Medicare and commercial health insurance claims data linked with EHRs for 2007-2014. The study included 23,339 adults diagnosed with HZ and 46,378 controls matched for sociodemographic and cardiovascular risk factors.
During the period from 1 month before to 1 month after HZ diagnosis, the rate of the composite vascular endpoint was 31.4 events per 1,000 person-years in the HZ group versus 24.5 per 1,000 person-years in controls. This difference was driven by a significantly higher rate of stroke/TIA in the HZ group. In contrast, the acute MI rates in the two groups were quite similar, at 6.9 per 1,000 person-years in the HZ group and 7.1 per 1,000 person-years in controls.
Further research is needed in order to shed light on the higher rate of vascular events observed in the younger patients with HZ. One possible explanation for the age-related difference is that HZ’s vascular effects is diluted in older patients, who have a higher burden of cardiovascular risk factors, Dr. Rausch noted.
The Centers for Disease Control and Prevention recommends the use of the two-dose recombinant Shingrix zoster vaccine in adults aged 50 years and older instead of the older, live-virus Zostavax vaccine, which is for adults aged 60 years and older.