A systematic review and meta-analysis on herpes zoster and the risk of cardiac and cerebrovascular events

Abstract

BackgroundPatients who develop herpes zoster or herpes zoster ophthalmicus may be at risk for cerebrovascular and cardiac complications. We systematically reviewed the published literature to determine the association between herpes zoster and its subtypes with the occurrence of cerebrovascular and cardiac events.Methods/ResultsSystematic searches of PubMed (MEDLINE), SCOPUS (Embase) and Google Scholar were performed in December 2016. Eligible studies were cohort, case-control, and self-controlled case-series examining the association between herpes zoster or subtypes of herpes zoster with the occurrence of cerebrovascular and cardiac events including stroke, transient ischemic attack, coronary heart disease, and myocardial infarction. Data on the occurrence of the examined events were abstracted. Odds ratios and their accompanying confidence intervals were estimated using random and fixed effects models with statistical heterogeneity estimated with the I2 statistic. Twelve studies examining 7.9 million patients up to 28 years after the onset of herpes zoster met our pre-defined eligibility criteria. Random and fixed effects meta-analyses showed that herpes zoster, type unspecified, and herpes zoster ophthalmicus were associated with a significantly increased risk of cerebrovascular events, without any evidence of statistical heterogeneity. Our meta-analysis also found a significantly increased risk of cardiac events associated with herpes zoster, type unspecified.ConclusionsOur results are consistent with the accumulating body of evidence that herpes zoster and herpes zoster ophthalmicus are significantly associated with cerebrovascular and cardiovascular events.

Reversal of pure red cell aplasia by varicella zoster virus infection

“…Also, in immunocompromised patients having VZV infection: atypical skin eruption may be encountered and disseminated infection may occur in the absence of skin lesions [48,50]. Constitutional symptoms and prodromal manifestations such as fever, malaise and local pain usually occur and they are followed by the typical skin eruptions of both chickenpox and herpes zoster [44,47,49,51]. VZV infections may be complicated by: secondary bacterial infection, pneumonia, post-herpetic neuralgia, stroke and other vasculopathies, meningoencephalitis, segmental weakness and myelopathy, cranial neuropathies, giant cell arteritis, Guillain-Barre syndrome, enteric complications, severe local infection such as Ramsay Hunt syndrome, visceral and disseminated involvement, and death particularly in immunocompromised patients and complicated cases [44,47,49,50].…”

Infectious Etiologies of Stroke

“…5 Recent meta-analyses have convincingly demonstrated an increased risk of cerebrovascular events after HZO, reported variably as both a relative risk of 1.9 6 and as an odds ratio of 4.42. 7 Subgroup analyses from both of these cohorts demonstrate increased risk of isolated ischemic stroke in addition to nonspecific cerebrovascular disease but do not clearly demonstrate increased risk of hemorrhagic stroke alone. While the greatest risk occurs 1 month following diagnosis, 6 risk of stroke is elevated for up to 1 year.…”

Precision Medicine and Vaccination of Older Adults: From Reactive to Proactive (A Mini-Review)

“…It is estimated that reactivation of latent herpes zoster infections may increase the risk of stroke by as much as 50% in the month immediately after reactivation, with the elevated risk potentially persisting for months [10]. A meta-analysis of published studies suggested that reactivation of herpes zoster increases the risk of a cerebrovascular or cardiovascular event by 20-40% and 10-30%, respectively, in the year after onset [29,30], and that vaccination may approximately halve this risk in adults aged 65-69 years [31]. The consistent temporal association of zoster and an elevated risk of developing cardiac or cerebrovascular disease, together with the observation that anti-viral therapy or vaccination appear to diminish risk, argue strongly for a causal effect [30].…”