Risk of, and risk factors for, vasculopathy associated with acute herpes zoster

Objectives: We aimed to summarize the known risk of vasculopathy (stroke, myocardial infarction [MI], and transient ischemic attack [TIA]) after herpes zoster (HZ) and the impact of antiviral treatment and vaccination against HZ on the risk of vasculopathy. Materials and methods: A narrative literature review was conducted in PubMed to identify evidence published in the past 15 years that was relevant to the scope of this article. Results: Ten studies reported that HZ was associated with an increased risk of stroke and one UK study reported no association. Four studies reported that HZ was associated with an increased risk of MI, and four reported that HZ was associated with an increased risk of TIA. Two studies reported that antiviral treatment was associated with a reduced risk of stroke and an additional two studies reported no association between antiviral treatment and the risk of stroke. In addition, two studies reported that vaccination against HZ using the live zoster vaccine (ZVL) was associated with a reduced risk of stroke, and an additional two studies reported that the risk of stroke or MI after HZ was similar between ZVL vaccinated and unvaccinated individuals. Conclusions: HZ is associated with an increased risk of stroke, MI, or TIA (strongest association is between HZ and stroke). Further studies are needed to determine whether antiviral treatment or ZVL vaccination influence the risk of HZ-associated vasculopathy. In addition, the effect of the recombinant zoster vaccine on the risk of HZ-associated vasculopathy should be studied. (c) 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Automated summary

This article reviews the known risk of vasculopathy (stroke, myocardial infarction, and transient ischemic attack) after herpes zoster (HZ) and the impact of antiviral treatment and vaccination against HZ on the risk. The results show a strong association between HZ and stroke, and further studies are needed to determine the influence of antiviral treatment or HZ vaccination on the risk of HZ-associated vasculopathy.