Herpes zoster increased stroke risk
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April 3, 2014
The incidence of herpes zoster increased the risk for stroke within the first 6 months of infection, according to researchers from the United Kingdom. However, antiviral therapy may decrease that risk.
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“There is mounting epidemiological evidence from different populations using different study designs of strong associations between acute systemic infections and risk of acute vascular events,” the researchers wrote in Clinical Infectious Diseases. “The effect of specific infections on acute vascular events including stroke has been less explored.”
Sinéad Langan, MD, PhD, and colleagues at the London School of Hygiene and Tropical Medicine identified 6,584 patients in the United Kingdom who had a first-ever diagnosis of herpes zoster and stroke between 1987 and 2012. The researchers compared the incidence of stroke after infection with herpes zoster with other periods in which patients were not recently exposed to the infection. They also examined patient health records to determine whether antiviral therapy had been delivered.
The incidence of stroke increased significantly within the first 4 weeks of infection with herpes zoster compared with the rate at baseline (incidence ratio [IR]=1.63; 95% CI, 1.32-2.02), and the stroke risk slowly diminished during the next 6 months (weeks 5-12: IR=1.42; 95% CI, 1.21-1.68; weeks 13-26: IR=1.23; 95% CI, 1.07-1.42).
In particular, patients with herpes zoster ophthalmicus faced more than a threefold increased risk for stroke 5 to 12 weeks after infection (IR=3.38; 95% CI, 2.18-5.24).
According to the researchers, 55% of patients with herpes zoster were treated with oral antiviral therapy, and the stroke risk for these patients was significantly lower vs. those who received no antivirals (weeks 1-4: IR=2.14; 95% CI, 1.62-2.84), suggesting a protective effect of antiviral treatment.
“The relatively low prescribing rates of antiviral therapy in U.K. general practice after developing shingles need to be improved, as our study suggests that stroke risks following shingles are lower in those treated with oral antiviral therapy compared to individuals not treated with antiviral therapy,” Langan said in a press release.
Infection with herpes zoster affects approximately 1 million people each year in the United States, and approximately 90,000 adults older than 60 years are infected annually in the United Kingdom, the researchers said.
Langan and colleagues said the association between herpes zoster and stroke can be explained by the development of varicella-zoster virus vasculopathy, which could trigger ischemic or hemorrhagic stroke.
In an accompanying editorial, Maria A. Nagel, MD, and Donald H. Gilden, MD, of the University of Colorado School of Medicine, wrote that the findings are supported by previous studies from the United Kingdom, Taiwan and Denmark.
However, “the current study is the first to show that the increased risk of stroke after zoster can be reduced with antiviral treatment,” they wrote.
For more information:
Langan SM. Clin Infect Dis. 2014;doi:10.1093/cid/ciu098.
Nagel M. Clin Infect Dis. 2014;doi:10.1093/cid/ciu099.