Abstract
BackgroundPatients who develop herpes zoster or herpes zoster ophthalmicus may be at risk for cerebrovascular and cardiac complications. We systematically reviewed the published literature to determine the association between herpes zoster and its subtypes with the occurrence of cerebrovascular and cardiac events.Methods/ResultsSystematic searches of PubMed (MEDLINE), SCOPUS (Embase) and Google Scholar were performed in December 2016. Eligible studies were cohort, case-control, and self-controlled case-series examining the association between herpes zoster or subtypes of herpes zoster with the occurrence of cerebrovascular and cardiac events including stroke, transient ischemic attack, coronary heart disease, and myocardial infarction. Data on the occurrence of the examined events were abstracted. Odds ratios and their accompanying confidence intervals were estimated using random and fixed effects models with statistical heterogeneity estimated with the I2 statistic. Twelve studies examining 7.9 million patients up to 28 years after the onset of herpes zoster met our pre-defined eligibility criteria. Random and fixed effects meta-analyses showed that herpes zoster, type unspecified, and herpes zoster ophthalmicus were associated with a significantly increased risk of cerebrovascular events, without any evidence of statistical heterogeneity. Our meta-analysis also found a significantly increased risk of cardiac events associated with herpes zoster, type unspecified.ConclusionsOur results are consistent with the accumulating body of evidence that herpes zoster and herpes zoster ophthalmicus are significantly associated with cerebrovascular and cardiovascular events.
Highlights
95% of American adults have a latent varicella zoster virus (VZV) infection arising from a primary infection, varicella [1]
We systematically reviewed the published literature to determine the association between herpes zoster and its subtypes with the occurrence of cerebrovascular and cardiac events
Our results are consistent with the accumulating body of evidence that herpes zoster and herpes zoster ophthalmicus are significantly associated with cerebrovascular and cardiovascular events
Summary
95% of American adults have a latent varicella zoster virus (VZV) infection arising from a primary infection, varicella (chickenpox) [1]. About one in every five individuals with latent VZV will develop herpes zoster (shingles), a reactivation of the virus that typically presents as a painful vesicular rash within a dermatome [2]. While this rash resolves in several weeks, herpes zoster may produce additional complications including post herpetic neuralgia, ocular pathologies, myelitis, and encephalitis [2]. Multiple case studies have reported the occurrence of stroke after the development of shingles, but have not quantified the magnitude of risk associated with this viral reactivation [4,5,6]. We systematically reviewed the published literature to determine the association between herpes zoster and its subtypes with the occurrence of cerebrovascular and cardiac events.
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