Neurology 2014 Jan 02;[EPub Ahead of Print], J Breuer, M Pacou, A Gauthier, MM Brown Research
January 08, 2014

TAKE-HOME MESSAGE

• This retrospective analysis from the U.K. of > 100,000 cases of herpes zoster (HZ) and > 200,000 matched controls showed HZ to be an independent risk factor for stroke, TIA, and MI, which can occur as late as 24 years after the acute episode.
• These data add to the mounting evidence that varicella-zoster virus is associated with vascular disease. Studies are needed to determine whether vaccination can reduce the incidence of HZ-associated vascular events, as has been the case with neuropathic complications.

ABSTRACT

OBJECTIVES

Stroke and TIA are recognized complications of acute herpes zoster (HZ). In this study, we evaluated HZ as a risk factor for cerebrovascular disease (stroke and TIA) and myocardial infarction (MI) in a UK population cohort.

METHODS

A retrospective cohort of 106,601 HZ cases and 213,202 controls matched for age, sex, and general practice was identified from the THIN (The Health Improvement Network) general practice database. Cox proportional hazard models were used to examine the risks of stroke, TIA, and MI in cases and controls, adjusted for vascular risk factors, including body mass index >30 kg/m2, smoking, cholesterol >6.2 mmol/L, hypertension, diabetes, ischemic heart disease, atrial fibrillation, intermittent arterial claudication, carotid stenosis, and valvular heart disease, up to 24 years (median 6.3 years) after HZ occurrence.

RESULTS

Risk factors for vascular disease were significantly increased in cases of HZ compared with controls. Adjusted hazard ratios (AHRs) for TIA and MI but not stroke were increased in all patients with HZ (AHR [95% confidence interval]: 1.15 [1.09–1.21] and 1.10 [1.05–1.16], respectively). However, stroke, TIA, and MI were increased in cases whose HZ occurred when they were younger than 40 years (AHR [95% confidence interval]: 2.42 [1.34–4.36], 1.49 [1.04–2.15], and 1.74 [1.13–2.66], respectively). Subjects younger than 40 years were significantly less likely to be asked about vascular risk factors than were older patients (p < 0.001).

CONCLUSION

HZ is an independent risk factor for vascular disease in the UK population, particularly for stroke, TIA, and MI in subjects affected before the age of 40 years. In older subjects, better ascertainment of vascular risk factors and earlier intervention may explain the reduction in risk of stroke after the occurrence of HZ.

Neurology
Herpes Zoster as a Risk Factor for Stroke and TIA: A Retrospective Cohort Study in the UK

Neurology 2014 Jan 02;[EPub Ahead of Print], J Breuer, M Pacou, A Gauthier, MM Brown

Full Story:  http://www.practiceupdate.com/journalscan/7491
Journal Reference:  http://www.neurology.org/content/early/2014/01/02/WNL.0000000000000038.short?rss=1