Risk of Stroke in Patients with Herpes Zoster: A Systematic Review and Meta-Analysis

Yang, Shengye; Li, Hongxing; Yi, Xiaolan; Han, Guopeng; Zong, Qiang; Wang, Mingxing; Peng, Xudong

doi:10.1016/j.jstrokecerebrovasdis.2016.09.021

Cited by 19 publications

(44 citation statements)

References 35 publications

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“…19 Another possible mechanism is that HZinduced chronic pain may increase the risk of CVD. 5,20,21 Our results revealed that the risk of HZ development after CVD was also significantly increased. Risk factors for HZ in previous studies were elderly age, female sex, white race, genetic susceptibility, underlying cell-mediated immune disorders, mechanical trauma and psychological stress.…”

Section: Discussionmentioning

confidence: 55%

“…The proposed mechanism is that direct infection of the VZV in vessels can result in pathological vascular remodeling, which leads to thrombosis, occlusion, infarction, aneurysm or hemorrhage . Another possible mechanism is that HZ‐induced chronic pain may increase the risk of CVD …”

Section: Discussionmentioning

confidence: 99%

“…In another meta-analysis, the authors showed that the risk of stroke was significantly increased after HZ, with an RR of 2.36 (95% CI, 2.17-2.56), 1.56 (95% CI, 1.46-1.66), 1.17 (95% CI, 1.13-1.22) and 1.09 (95% CI, 1.02-1.16) for the first 2 weeks, first month, first year and thereafter, respectively. 4,5 Despite conflicting associations between hemorrhagic stroke and HZ, the majority of studies have shown a consistent association between ischemic stroke and HZ. 5,[13][14][15] Yang et al 5 showed that HZ was strongly associated with ischemic stroke (RR, 1.99; 95% CI, 1.04-3.81), but not hemorrhagic stroke (RR, 1.86; 95% CI, 0.76-4.54) through their meta-analysis of six cohort studies.…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 90% of CVD is thought to be preventable, and studies have been actively conducted on the risk factors for CVD . Recently, HZ has been identified as a risk factor for stroke, but there have been few studies on the relationship between HZ and other CVD, including MI or HF …”

Section: Introductionmentioning

confidence: 99%

“…3 Recently, HZ has been identified as a risk factor for stroke, but there have been few studies on the relationship between HZ and other CVD, including MI or HF. 4,5 The elderly and people with decreased cell-mediated immunity are at increased risk of HZ. 6 However, little is known about risk factors for HZ in people without underlying immunosuppression.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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

Seo

Cha

Han

et al. 2018

The Journal of Dermatology

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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.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Seo

Cha

Han

et al. 2018

The Journal of Dermatology

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Correlation between herpes zoster and stroke—A case–control study

Hosamirudsari

Rashed

Afsari

et al. 2018

Journal of Medical Virology

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Cerebrovascular accident is the second most common cause of death in the world. Herpes zoster (HZ) is reported to be a major trigger of the stroke syndrome. Considering the high prevalence of stroke in Iran, we carried out a study to assess the correlation between stroke and HZ. This is one of the very few studies carried out on this correlation in Asian nations. One hundred and five cases and 105 controls were included in this study. The cases had been diagnosed with stroke by a neurologist and confirmed by brain imaging. The controls had never had any type of stroke. Both groups were between 30 and 90 years of age. We looked for the HZ infection in both groups. Logistic regression analysis was used to evaluate the association between stroke and HZ. The mean age of the cases was 63.95 ± 12.24 years and the man age of the controls was 66.99 ± 14.58 years. There was a significant difference in the HZ infection between the cases and the controls (P < .0001). Head zoster (including ophthalmic zoster) was significantly higher in the case group than the control group (P < .0001). The risk of stroke was the highest 2-4 weeks after the onset of HZ and the incidences of ischemic stroke were higher than those of hemorrhagic stroke (P < .0001). In an analysis adjusted for the age, sex, and hypertension, HZ was found to be associated with an increased risk of stroke (odds ratio, 5.84; 95% confidence interval, 1.98-8.23). Close monitoring is suggested for cerebrovascular diseases in patients who have had the head zoster, especially in the first month after the infection.

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A comprehensive, updated systematic review and meta‐analysis of epidemiologic evidence on the connection between herpes zoster infection and the risk of stroke

Heiat,

Salesi,

Peypar

et al. 2024

Reviews in Medical Virology

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Stroke is a common worldwide cause of death and disability, resulting from an obstruction or reduction in blood flow to the brain. Research has demonstrated that systemic infection such as herpes zoster (HZ) / ophthalmicus herpes zoster (HZO) can potentially trigger stroke. This study includes an updated systematic review and meta‐analysis of the epidemiologic data on the connection between HZ/HZO infection and the risk of stroke. A meticulous search of different database yielded 905 studies. Furthermore, an additional 14 studies from a previous meta‐analysis were incorporated. Eligible studies underwent rigorous screening, resulting in 18 papers. Statistical analyses, including random/fixed effects models and subgroup analyses, were conducted to assess pooled relative risk (RR) and heterogeneity. The meta‐analysis consisted of 5,505,885 participants and found a statistically significant association between HZ infection and the risk of stroke (pooled RR = 1.22, 95% confidence interval [CI] 1.12–1.34). The HZO infection showed a significantly higher overall pooled RR of 1.71 (95% CI 1.06–2.75), indicating a strong connection with the risk of stroke. Subgroup analysis revealed that the odds ratio might play a significant role in causing heterogeneity. Time since infection emerged as a crucial factor, with heightened stroke risk in the initial year post‐HZ/HZO exposure, followed by a decline after the first year. Asian/Non‐Asian studies demonstrated varied results in HZ/HZO patients. Meta‐analysis reveals a significant HZ/HZO‐stroke link. Subgroups highlight varied risks and warrant extended Asian/non‐Asian patient investigation.

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Risk of Stroke in Patients with Herpes Zoster: A Systematic Review and Meta-Analysis

Cited by 19 publications

References 35 publications

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

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

Correlation between herpes zoster and stroke—A case–control study

A comprehensive, updated systematic review and meta‐analysis of epidemiologic evidence on the connection between herpes zoster infection and the risk of stroke

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