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Review
. 2019 Apr 22;8(4):547.
doi: 10.3390/jcm8040547.

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

Ping-Hsun Wu  1   2   3 , Yun-Shiuan Chuang  4 , Yi-Ting Lin  5   6   7
Affiliations
Review

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

Ping-Hsun Wu et al. J Clin Med. .

Abstract

Herpes zoster (HZ) caused by varicella zoster virus (VZV) reactivation is characterized as a vesicular rash of unilateral distribution that can also cause multiple complications; such as post-herpetic neuralgia; ophthalmic zoster; and other neurological issues. VZV can also increase incident hemorrhagic or ischemic complications by causing inflammatory vasculopathy. Thus; emerging epidemiological and clinical data recognizes an association between HZ and subsequent acute strokes or myocardial infarction (MI). This study reviewed published articles to elucidate the association between HZ and cerebrovascular and cardiac events. Individuals exposed to HZ or herpes zoster ophthalmicus had 1.3 to 4-fold increased risks of cerebrovascular events. Higher risks were noted among younger patients (age < 40 years) within one year after an HZ episode. The elevated risk of CV events diminished gradually according to age and length of time after an HZ episode. The putative mechanisms of VZV vasculopathy were also discussed. Several studies showed that the development of herpes zoster and herpes zoster ophthalmicus increased the risks of stroke; transient ischemic attack; and acute cardiac events. The association between VZV infection and cardiovascular events requires further studies to establish the optimal antiviral treatment and zoster vaccination to reduce zoster-associated vascular risk.

Keywords: cardiovascular disease; herpes zoster; myocardial infarction; stroke.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The results of meta-analyses examining the relative risk (RR) of stroke within different lengths of follow-up after herpes zoster episodes. TIA, transient ischemic attack; MI, myocardial infarction.
Figure 2
Figure 2
The results of meta-analyses and enrolled cohorts examining the risk of stroke or myocardial infarction after herpes zoster episodes in different age ranges. TIA, transient ischemic attack; MI, myocardial infarction; HR, hazard ratio; IRR, incident rate ratio.
Figure 3
Figure 3
Meta-regression of the post-HZ length of follow-up (A) or age of the subjects (B) and relative risk of stroke/TIA in post-HZ patients. HZ, herpes zoster.
Figure 4
Figure 4
The potential mechanism of varicella zoster virus (VZV)-associated vascular events.
See this image and copyright information in PMC

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