Herpes zoster linked to vascular events

  • Patterson BJ & al.
  • Mayo Clin Proc
  • 04/04/2019

  • Liz Scherer
  • Clinical Essentials
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Takeaway

  • Herpes zoster (HZ) is associated with a significantly increased risk of composite cardiovascular (CV) events, transient ischemic attacks (TIA), and stroke in adults around diagnosis (aggregate period, through week 4 post-HZ index date).
  • 1 year post-HZ, risk appears to be similar in magnitude of general, age-adjusted population.

Why this matters

  • Consider CV events risk in adults ≥50 years presenting with HZ.
  • Ensure that eligible patients are vaccinated.

Key results

  • 23,339 with HZ matched in 1:2 ratio to 46,378 control patients.
  • Unadjusted incidence rate ratios (IRRs) in aggregate significantly highest for composite events (IRR, 1.28), TIA (IRR, 1.53), P<.05 vs cohorts.>
  • Adjusted IRR: HZ patients, ages 18-49 years, were significantly likelier to suffer a TIA (IRR, 1.66; P=.001) or composite event (IRR, 1.77; P<.001>
  • Post hoc sensitivity analysis: regardless of age, likelihood of a TIA (IRR, 1.61; 95% CI, 1.48-1.74), stroke (IRR, 1.42; 95% CI, 1.29-1.58), or composite event (IRR, 1.40; 95% CI, 1.32-1.49) remained significantly higher among HZ patients during the aggregate period (P<.001>

Study design

  • Retrospective, longitudinal, matched cohort analysis of risk of TIA, stroke, myocardial infarction after first HZ diagnosis.
  • Funding: GlaxoSmithKline Biologicals SA.

Limitations

  • Covariates, outcomes misclassification.
  • Nongeneralizable.