Shingles and Cardiovascular Disease for Professionals
Educate your patients who have cardiac issues or risks on the preventable impact of shingles.
About 1 in 3 adults in the United States will develop shingles in their lifetime. The infection causes a painful rash and occurs when the varicella-zoster virus (VZV), the same virus that causes chickenpox, activates again in the body. The rash can be treated with antiviral drugs and usually doesn’t recur.
Shingles can have serious neurological complications. The most common is postherpetic neuralgia (PHN), pain persisting after the rash goes away. Rare complications include pneumonia, hearing problems, blindness and brain inflammation (encephalitis).
Cardiovascular effects of shingles
Several studies find that a previous shingles outbreak increases by 30% the risk of incidents such as stroke or coronary heart disease. These risks extend to 12 years or longer.
- Risk for stroke was up to 38% higher among people with a history of shingles.
- For coronary heart disease, which included having a heart attack or requiring a procedure such as a coronary artery bypass graft, the risk was up to 25% higher.
People who are immunocompromised may be at an increased risk for these events. They include people with medical conditions such as:
- Cancers like leukemia and lymphoma
- HIV infection
- those who are taking drugs that interfere with the immunity system, such as steroids and drugs given after an organ transplant
Vaccine Recommendations
The Centers for Disease Control and Prevention recommends the recombinant zoster vaccine (RZV) in the U.S. for adults age 50 or older and for people 19 and older with compromised immune systems. It’s given as two doses, two to six months apart.
As well as being highly effective against shingles and PHN, the RZV may be associated with reduced cardiovascular disease risk:
- A meta-analysis found that vaccination was associated with a significantly lower risk of stroke and myocardial infarction, about 16-18%, when compared to non-vaccinated people.
- In one study, the vaccine was found to decrease the risk of overall cardiac events by 23% and major cardiac events by 26%, with the protective association persisting up to 8 years.
Responding to shingles and cardiovascular issues
Consider RZV as part of broader preventive care, especially for patients at cardiovascular risk:
- People 50 and older and younger adults with compromised immunity should be routinely assessed for vaccination eligibility.
- RZV can be co-administered with other vaccines, such as for flu and COVID-19, at different anatomical sites during the same visit.
- Screening for prior infection is not required; most adults are eligible regardless of past chickenpox or shingles history.
