MONDAY, Dec. 5, 2022 (HealthDay News) — People who have had a bout of shingles may face an increased risk of heart attack or stroke in years to come, according to a large new study.
Anyone who has ever had chickenpox can develop shingles – a painful rash caused by a reactivation of the virus that causes chickenpox. About a third of Americans will develop shingles in their lifetime, according to the US Centers for Disease Control and Prevention.
The new study, of more than 200,000 American adults, found that those who had suffered a bout of shingles were up to 38% more likely to suffer a stroke in the next 12 years, compared to those who remained shingles-free. Meanwhile, their risk of heart disease, which includes heart attack, was up to 25% higher.
The results, recently published in the Journal of the American Heart Association, do not prove that shingles directly increases the risk of cardiovascular disorders.
But it’s biologically plausible, the researchers say: the reactivated virus can enter blood vessels, causing inflammation, and it could contribute to cardiovascular “events” like heart attack and stroke.
Some previous studies have shown that cardiovascular risks may increase after shingles, but they looked at the short term.
It’s unclear how long this risk persists, said Dr. Sharon Curhan, lead researcher of the new study.
“Our results demonstrate that shingles is associated with a significantly higher long-term risk of a major cardiovascular event, and the elevated risk may persist for 12 or more years after having shingles,” said Curhan, of Brigham and Women’s Hospital, Boston.
It’s an important finding, said Dr. Elisabeth Cohen, an ophthalmologist and professor at NYU Grossman School of Medicine, New York.
“What they show is that the short-term risk doesn’t go away,” said Cohen, who studies eye disease related to shingles.
Although shingles is very common, it’s not taken as seriously as it should be, according to Cohen.
It all starts with the chicken pox virus, called varicella zoster. Once a person contracts this virus – like almost all Americans born before 1980 – it lies dormant in the body, hiding in the nerves.
Generally, the immune system controls the virus. But when a person’s immune function weakens – due to age, illness or medication, for example – the varicella-zoster virus can reactivate, causing shingles.
Typically, shingles causes a painful rash consisting of fluid-filled blisters and usually clears up within a few weeks, according to the CDC.
In some cases, shingles affects the area around the eye – a condition called ophthalmic shingles – which can lead to serious problems such as ulcers on the cornea and lasting vision loss. Meanwhile, between 10% and 18% of people with shingles develop postherpetic neuralgia (PHN), nerve pain that can last for months or even years after the rash goes away.
Shingles eye disease, Cohen said, is linked to an increased risk of short-term stroke, compared to milder shingles.
The latest study looked at shingles as a whole. Curhan said it’s unclear whether shingles complications, such as PHN and eye disease, are linked to a greater increase in the risk of heart disease and stroke in the long term.
For much of the study period, there was no shingles vaccine.
The good news is that there is now a very effective one, the two doctors said.
“The shingles vaccination could provide a valuable opportunity to reduce the burden of shingles and possibly reduce the risk of cardiovascular complications,” Curhan said.
The CDC recommends adults 50 and older get two doses of the shingles vaccine, called Shingrix. It is also recommended for people 19 years and older who have a weakened immune system due to illness or medical treatments.
The vaccine is more than 90% effective in preventing shingles and PHN in healthy adults, with immunity remaining strong for at least seven years, according to the CDC. It is somewhat less effective for people with weakened immunity.
The latest findings are based on more than 200,000 US healthcare professionals who have been followed for up to 16 years. During this period, just over 3,600 had a stroke, while 8,620 developed heart disease.
Overall, people with a history of shingles were up to 38% more likely to experience a stroke, with the risk being highest five to eight years after shingles. Likewise, their risk of heart disease was up to 25% higher, peaking nine to 12 years after their shingles episode.
Those were the risks after the researchers took into account many other factors, including age, chronic health conditions, weight, exercise habits and smoking.
Anyone unlucky enough to have had shingles can unfortunately catch it again, Cohen pointed out. So these people should also be vaccinated when they are eligible.
“Most of us who’ve had shingles — and I’m one of them — never want to have them again,” Cohen said.
The United States Centers for Disease Control and Prevention has more on shingles.
SOURCES: Sharon Curhan, MD, ScM, physician and epidemiologist, Brigham and Women’s Hospital, Harvard Medical School, Boston; Elisabeth Cohen, MD, professor of ophthalmology, NYU Grossman School of Medicine, New York; Journal of the American Heart Association, Nov 16, 2022, online
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