Reciprocal relationship between herpes zoster and cardiovascular diseases: A nationwide population‐based case–control study in Korea

Abstract

Recently, herpes zoster (HZ) has been identified as a risk factor for stroke, but there have been few studies on the relationship between HZ and other cardiovascular diseases (CVD), including myocardial infarction (MI) and heart failure (HF). The purpose of this study was to investigate the risk of HZ occurrence after CVD and the occurrence of CVD after HZ. This was a retrospective case-control study based on the National Health Insurance System claims database for 20 311 patients with HZ and 13 980 patients with CVD and 1:5 age- and sex-matched control subjects for each from January 2006 to December 2013. We evaluated the reciprocal relationship between HZ and CVD including MI, ischemic stroke and HF. Severe HZ requiring hospitalization independently increased the risk of subsequent MI (hazard ratio [HR], 1.831; 95% confidence interval [CI], 1.354-2.476)], ischemic stroke (HR, 1.523; 95% CI, 1.212-1.915) and HF (HR, 2.034; 95% CI, 1.615-2.562) during the study period. Likewise, patients with an episode of MI, ischemic stroke or HF were also at increased risk of HZ hospitalization (after MI: HR, 1.625; 95% CI, 1.144-2.308; after stroke: HR, 1.518; 95% CI, 1.177-1.957; and after HF: HR, 1.485, 95% CI 1.041-2.117). Our results suggest that there is a significant reciprocal relationship between severe HZ requiring hospitalization and CVD including MI, ischemic stroke and HF.

Does Herpes Zoster Increase the Risk of Stroke and Myocardial Infarction? A Comprehensive Review

“…Text headings and medical subject heading (MeSH) terms used in the searches included HZ, shingles, HZO, stroke, TIA, cerebrovascular disease, and MI. Fifteen studies examined the associations between unspecified HZ types and the following: Non-specified stroke [2,3,4,5,6,7,8,9], ischemic stroke [7,10,11], hemorrhagic stroke [7], transient ischemic attack (TIA), a composite of stroke and TIA [12,13], myocardial infarction (MI) [2,5,9,10,11], acute coronary syndromes (MI and unstable angina) [14], and incident coronary artery disease, including angina and MI (Table 1, Table 2) [15]. There were also eight studies regarding HZO and cardiovascular disease (CVD), five studies of non-specified stroke [2,3,6,7,16], and studies with ischemic stroke [10], hemorrhagic stroke [7], and MI [10] as endpoints (Table 3).…”

“…Recent epidemiological studies ( n = 15) from Asia (Taiwan [3,14,15,16] and Korea [9,11,12]), Iran [8], Europe (the United Kingdom [2,6], Germany [7], Demark [13], and Sweden [4]), and the United States [5,10] showed an increased incidence of stroke or MI in patients with a recent history of zoster. The characteristics of the 15 studies are displayed in Table 1, Table 2 and Table 3.…”

“…Different databases were used in these studies, including the Taiwanese National Health Insurance Research Database (NHIRD) [3,14,15,16], the United Kingdom’s Clinical Practice Research Datalink (CPRD) and the Health Improvement Network (THIN) general practice databases [2,6], the Danish registry [13], the Swedish registry [4], the German Pharmacoepidemiological Research Database (GePaRD) [7], the US Medicare Database [10] and Olmsted County residents [5], and the Korean Health Insurance Database [9,11,12]. The study designs included a case-control study [8], retrospective cohort studies [2,3,4,5,11,12,13,14,15,16], a propensity score-matching approach [9], and self-controlled case series analyses [6,7,10] with adjustment for age, sex, and CVD risk factors (for example, hypertension diabetes, congestive heart failure, dyslipidemia, ischemic heart disease, atrial fibrillation, intermittent arterial claudication, carotid stenosis, and valvular heart disease). Among these studies, Sundström et al [4] used only age and sex for adjustment, and Breuer et al [2] and Langan et al [6] further controlled for smoking and obesity.…”

“…Kwon et al [12] reported higher risk of stroke/TIA (IRR, 1.90; 95% CI, 1.85–1.95) and Kim et al [9] further found that HZ was associated with a 35% increased risk of stroke (HR 1.35; 95% CI, 1.18–1.54) and a 59% increased risk of MI (HR 1.59; 95% CI, 1.27–2.01) in a propensity score-matched analysis. In addition, Seo et al [11] showed that severe HZ requiring hospitalization increased the risk of MI (HR, 1.83; 95% CI, 1.35–2.48) and ischemic stroke (HR, 1.52; 95% CI, 1.21–1.92). In the USA, Yawn et al [5] compared 4862 individuals older than 50 years versus 19,433 control matched individuals and found a recent episode of herpes zoster was associated with a higher risk of stroke or MI.…”

Higher risk of herpes zoster in stroke patients

“…In one case-control study in Korea, Seo et al showed a significant increased risk of severe HZ requiring hospitalization in ischemic stroke. However, no studies have linked the risk of HZ occurrence to hemorrhagic stroke [21]. Therefore, the aim of this study was to survey whether HZ risk is higher in persons with stroke compared to the general population and the relevance to different type of stroke.…”