Analysis of Vascular Event Risk After Herpes Zoster From 2007 to 2014 US Insurance Claims Data

Abstract

Objective: To estimate the risk of transient ischemic attack (TIA), stroke, and myocardial infarction in periods covering 4 weeks before to 52 weeks after herpes zoster (HZ) diagnosis in US adults. Patients and Methods: This retrospective study (GSK study identifier: HO-15-15771) with matched cohorts used the Truven Health MarketScan Commercial and Medicare claims data set linked with obesity and smoking status information. Patients 18 years and older at the date of HZ diagnosis and 1year pre-and post-HZ diagnosis continuous insurance enrollment (from January 1, 2007, through December 31, 2014) were propensity score matched to controls in terms of demographic characteristics, risk factors for vascular events, other comorbid disorders, general health, obesity, and smoking status. A post hoc sensitivity analysis was performed not matching for obesity and smoking status information. Adjusted incidence rate ratios (IRRs) were estimated using multivariate Poisson models during an aggregate period (1-month before and after the index date). Results: A total of 23,339 patients with HZ were matched to 46,378 controls (mean age, 56 years; 45,173 [65%] women). During the aggregate period, patients with HZ were statistically significantly more likely to suffer a TIA: IRRs for all patients and patients aged 18 to 49 years were 1.56 (95% confidence interval [CI], 1.13-2.15) and 5.12 (95% CI, 1.37-19.10), respectively (P<.05); the respective IRRs for stroke were 1.40 (95% CI, 0.93-2.11) and 8.12 (95% CI, 0.93-71.27). In the sensitivity analysis, IRRs for TIA and stroke were statistically significantly increased regardless of age. Conclusion: Herpes zoster was associated with an increased risk of composite events, TIA, and stroke in adults in the period around diagnosis. More research on the HZ and vascular risk association is needed.

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“…Coronary artery disease, arrhythmias, hypertension, dyslipidemia, diabetes, myocardial infarction, anxiety, depression, stroke, and transient ischemic attack are more frequent among older adults aged ≥ 50 years with a history of HZ compared with their peers without a history of HZ [ 27 , 28 ]. Large studies conducted in the USA have shown an association between HZ and the risk of stroke [ 27 , 29 ]. Asthma is more frequent among patients with HZ than among non-HZ patients [ 30 ].…”

“…Asthma is more frequent among patients with HZ than among non-HZ patients [ 30 ]. Following HZ, older adults aged ≥ 50 years have a 38% [ 29 ] to 53% increased likelihood of experiencing a stroke [ 27 ], and a 60% increased likelihood for a transient ischemic attack compared with peers without a history of HZ [ 29 ]. Neurologic complications occur in 25–70% patients with infectious endocarditis [ 31 ].…”

Vascular Event Risk After Herpes Zoster

“…To the Editor: We have read the article by Patterson et al 1 published in the April 2019 issue of Mayo Clinic Proceedings. The authors performed an interesting study using propensity score to evaluate the cardiovascular disease risk during the prodromal period and aggregate period of herpes zoster (HZ) infection.…”

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“…1 PHN is the most common complication of HZ; it can be particularly debilitating, slow to resolve, and difficult to relieve by analgesia. 6 Other complications are rarer such as HZ ophthalmicus (eye complications including keratitis, uveitis/iritis, conjunctivitis, and loss of vision 3,7 ); more recently HZ has been associated with an increased vascular risk particularly affecting younger HZ sufferers, 8 with the increased risk of stroke or cardiovascular event diminishing gradually according to age and length of time after the HZ episode. 9 HZ has a significant burden on quality of life, with 90% of patients reporting pain as the predominant symptom.…”