HealthDay News — Experiencing a shingles episode in young adulthood or early middle age is an independent risk factor for vascular disease, including stroke, transient ischemic attack (TIA) and myocardial infarction (MI), results of a British epidemiological study indicate.

In a cohort of more than 100,000 people in Great Britain whose medical records indicated an episode of herpes zoster, risk for stroke nearly doubled among those with an episode prior to age 40 compared with age-, sex- and location-matched controls (adjusted hazard ratio 1.74; 95% CI: 1.13-2.66), Judith Breuer, MD, of University College of London and colleagues reported in Neurology.

Risk for TIA (HR 2.42; 95% CI: 1.34-4.36) and MI (HR 1.49; 95% CI: 1.04-2.15) were also significantly higher in this population. There was little or no risk for these vascular events in patients who experienced a shingles attack after age 40 years, the researchers found.

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They suggested all patient with latent herpes zoster infection and risk factors for vascular disease should be offered herpes zoster vaccination, regardless of age, to reduce the associated vascular risks.

“[S]creening for vascular risk factors in patients presenting with herpes zoster, especially younger patients in whom intervention may have the most impact, should now be encouraged. Ultimately, high-coverage childhood varicella vaccination to reduce latency with wild-type virus is altogether desirable,” Breuer and colleagues wrote.

The retrospective analysis included data on 106,601 cases of single-episode herpes zoster attacks in adults aged 18 years and older and 213,202 age-, sex-, and general practice-matched controls identified in The Health Improvement Network general practice database.

The risks of stroke, TIA, and MI were assessed, after adjusting for vascular risk factors, up to 24 years after herpes zoster occurrence (median, 6.3 years). Total person-years of follow-up for cases amounted to 781,740. Patients with recurrent episodes were excluded because such cases frequently represent misdiagnosed herpes simplex infections.

The researchers adjusted for baseline vascular risk factors including BMI, smoking status, history of high cholesterol, and diagnoses of diabetes, ischemic heart disease, atrial fibrillation, intermittent arterial claudication, carotid stenosis and valvular heart disease.

Across the entire group of cases, the risks of TIA and MI were increased slightly compared with controls (HR 1.17 and 1.15, respectively, P<0.05), but not for stroke (HR 1.04, not significant). Most of the increased risk appeared to be concentrated in those individuals with early shingles attacks.

The researchers suggested the increased risk may have something to do with clinical habits and official recommendations rather than the biology of herpes zoster infection. Overall stroke rates have decline 30% in Britain in the past decade, which is believed to be attributable to screening older patients for risk factors and treating accordingly. 

In this study, subjects younger than 40 years were significantly less likely to be asked about vascular risk factors compared with older patients (P<0.001).

However, a potential biological explanation for the increased risk cannot be ruled out. Herpes zoster virus, which continues to circulate after a shingles episode, infects arterial tissue and may make younger people with other vascular risk factors particular susceptible to acute vascular events, the researchers suggested. 

“Population studies are now needed to evaluate whether immunization to prevent herpes zoster could also reduce the incidence of vascular events including stroke, TIA, and MI,” the researchers wrote.


  1. Breuer J et al. Neurology. 2014; doi:1212/WNL.0000000000000038.