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Acute Cardiovascular Events after Herpes Zoster: A Self-Controlled Case Series
Analysis in Vaccinated and Unvaccinated Older Residents of the United States
#MMPMID26671338
Minassian C
; Thomas SL
; Smeeth L
; Douglas I
; Brauer R
; Langan SM
PLoS Med
2015[Dec]; 12
(12
): e1001919
PMID26671338
show ga
BACKGROUND: Herpes zoster is common and can have serious consequences.
Additionally, emerging data suggest an increased risk of acute cardiovascular
events following herpes zoster. However, to our knowledge, existing association
studies compare outcomes between individuals and are therefore vulnerable to
between-person confounding. In this study, we used a within-person study design
to quantify any short-term increased risk of acute cardiovascular events (stroke
and myocardial infarction [MI]) after zoster and to assess whether zoster
vaccination modifies this association. METHODS AND FINDINGS: The self-controlled
case series method was used to estimate rates of stroke and acute MI in defined
periods after herpes zoster compared to other time periods, within individuals.
Participants were fully eligible Medicare beneficiaries aged ? 65 y with a herpes
zoster diagnosis and either an ischemic stroke (n = 42,954) or MI (n = 24,237)
between 1 January 2006 and 31 December 2011. Age-adjusted incidence ratios (IRs)
for stroke and MI during predefined periods up to 12 mo after zoster relative to
unexposed time periods were calculated using conditional Poisson regression. We
observed a marked increase in the rate of acute cardiovascular events in the
first week after zoster diagnosis: a 2.4-fold increased ischemic stroke rate (IR
2.37, 95% CI 2.17-2.59) and a 1.7-fold increased MI rate (IR 1.68, 95% CI
1.47-1.92), followed by a gradual resolution over 6 mo. Zoster vaccination did
not appear to modify the association with MI (interaction p-value = 0.44). We
also found no evidence for a difference in the IR for ischemic stroke between
vaccinated (IR 1.14, 95% CI 0.75-1.74) and unvaccinated (IR 1.78, 95% CI
1.68-1.88) individuals during the first 4 wk after zoster diagnosis (interaction
p-value = 0.28). The relatively few vaccinated individuals limited the study's
power to assess the role of vaccination. CONCLUSIONS: Stroke and MI rates are
transiently increased after exposure to herpes zoster. We found no evidence for a
role of zoster vaccination in these associations. These findings enhance our
understanding of the temporality and magnitude of the association between zoster
and acute cardiovascular events.
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