This is for our readers who treat chronic pain patients
Author: Robby Berman
- Health experts and researchers have long suspected that shingles can lead to stroke and coronary heart disease.
- New research has found that the association between shingles and cardiovascular events is more significant than previously thought.
- The long-term study reveals that the association also lasts for a much longer duration than previously understood.
- The best strategy for self-protection, according to experts, is to get a shingles vaccine and prioritize heart health through diet and lifestyle modifications.
Experts have known for some time that an association exists between shingles, stroke, and coronary heart disease.
A new prospective, longitudinal study from researchers at Brigham and Women’s Hospital in Boston, MA, adds greater depth to this understanding, finding a stronger association between shingles and these cardiovascular events than previously thought.
The findings show that adults who’ve had shingles were nearly 30% more likely to have a subsequent first stroke or develop coronary heart disease.
The study, which followed individuals for up to 16 years, suggests the risk extends for a longer duration after an active case of shingles than what was previously known.
In addition, people who’ve had shingles are more likely to experience cardiovascular problems for 12 years or more.
The study was recently published in the Journal of the American Heart Association.
The study analyzed data from 205,030 adults who participated in three separate studies.
The cohort included 79,658 women from the Nurses’ Health Study, 93,932 women from the Nurses’ Health Study II, and 31,440 men from the Health Professionals Follow-up Study.
People with prior histories of strokes or coronary disease were excluded from the research.
Participants completed questionnaires at enrollment in their respective studies and completed follow-up questionnaires every 2 years. All were health professionals.
Although shingles cases and subsequent coronary events were self-reported, crosschecks with participants’ physicians found that the self-reports were highly accurate.
The study’s lead author, Dr. Sharon E. Curhan, an epidemiologist and physician at the Brigham and Women’s Hospital’s Channing Division of Network Medicine, told Medical News Today:
“Although some previous studies showed a higher risk of stroke or heart attack around the time of the shingles infection, it was not known whether this higher risk persisted in the long term.”
Dr. Curhan explained her study found that for a first, or incident, stroke, the risk is up to 38% higher among people with a history of shingles compared to people with no such history.
Coronary heart disease was 25% more likely in people who’ve had shingles.
Dr. Rigved Tadwalkar, a board certified cardiologist at Providence Saint John’s Health Center in Santa Monica, CA, not involved in the study, told MNT:
“It seems from that data the risk sort of peaks somewhere in the 5- to 12-year range, but perhaps it may persist thereafter. The findings were surprising both due to the magnitude of the elevated risk and the long duration of time that the risk remained elevated.”
Research on shingles and cardiovascular events can only identify associations or correlations. This means that researchers cannot yet firmly establish that one thing, such as shingles, causes another, such as stroke or coronary heart disease.
As such, experts can only theorize about the connection between them.
Shingles is caused by the herpes zoster virus. According to Dr. Tadwalkar, “it’s the only human virus known to replicate in the arteries, and this is in all types of arteries, large and small.”
Dr. Tadwalkar added the vasculopathy, or changes in blood vessels, that occur with shingles include arterial wall damage and endothelial dysfunction that disrupts plaque and changes how blood clots.
“When you take all of these microscopic mechanisms and then couple them with the inflammatory burden that the virus creates, you have a perfect storm,” Dr. Tadwalkar said.
When a person gets chickenpox, its virus, varicella-zoster, remains indefinitely inactive in the nervous system.
The current understanding is that if the immune system fails to control the replication of this latent virus, it reactivates in the dorsal root nerve ganglion near the spinal cord as herpes zoster, and symptoms of shingles appear.
Shingles may appear as a painful rash that typically lasts 2 to 4 weeks.
It often presents as a girdle of blisters running across parts of the chest, back, or abdomen. (“Zoster” means “girdle” in ancient Greek.)
Currently, most people who get shingles are over 50, having had chickenpox as children.
Younger people are more likely to have been vaccinated against the disease. Having never had chickenpox, they have no dormant varicella-zoster virus.
As the population in the United States ages, shingles cases are on the rise.
Dr. Curhan explained that due to the study’s extended follow-up period, much of it covered a time before a shingles vaccine was widely available.
“The more recent non-live, recombinant subunit adjuvanted vaccine was not available until after the end of follow-up in our study,” she noted.
“Given the growing number of Americans at risk for shingles, which can be a painful and disabling disease, and the availability of an effective vaccine, shingles vaccination could provide a valuable opportunity to reduce the burden of shingles and also possibly to reduce the risk of subsequent cardiovascular complications.”
– Dr. Sharon E. Curhan, lead author of the study
Health authorities recommend that everyone over 50 get the shingles vaccine, except for people who have had adverse reactions to vaccines in the past.
Even if a person has already had shingles, Dr. Tadwalkar said that being vaccinated can help prevent further flare-ups.
He also recommended that people with active cases of shingles get treated appropriately with antiviral therapy within 72 hours of disease onset.
“You can make an argument because if you’re reducing your recurrence of shingles, or you’re having fewer episodes, over the course of time, then, theoretically, you’re also having less of the vascular issues that [the] virus can create,” Dr. Tadwalkar said.
He added that as a person ages, their risk of stroke and coronary heart disease generally increases, making shingles just one of many potential causes.
Beyond vaccination, if you’ve had shingles, the standard best practices for avoiding cardiovascular disease still apply. According to Dr. Curhan, ideal strategies for heart health include:
- eating a healthful diet
- maintaining a healthy weight
- staying physically active
- not smoking
- managing chronic health conditions (i.e., high blood pressure, diabetes, and elevated cholesterol)
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