Cardiovascular patients have long been identified as being at greater risk when it comes to herpes zoster (HZ) because they have a more difficult time fighting off the virus and because complications from the virus can be more serious. It now appears that patients who have no history of cardiac issues may be vulnerable as well, and face an increased likelihood of myocardial infarction (MI) and stroke after HZ.
“Once you have cardiovascular disease, you’re at such a greater risk of the structures in life influencing your recurrence rate,” says Martha Gulati, MD, FACC, chief of cardiology at the University of Arizona College of Medicine. She routinely recommends that patients with a history of cardiovascular disease or stroke be immunized against shingles and other illnesses that put an already compromised heart at greater risk.
Gulati notes that people with other medical conditions—including high blood pressure, diabetes, and high cholesterol—should also be vaccinated to reduce their risk. “For example, someone with diabetes may have a weaker immune system already, and then they get this activation of the herpes virus and develop shingles,” she explains. “That stress on the heart and on the physiologic system increases the risk for heart disease or stroke.”
The recent study called Analysis of Vascular Event Risk After Herpes Zoster From 2007 to 2014 US Insurance Claims Data explored the association between HZ and an increased risk of cardiovascular events. Using a large national insurance claims database and matched controls, the researchers set out to estimate the risk of myocardial infarction, stroke, and transient ischemic attack (TIA) during the period from four weeks before to one year after the HZ diagnosis.
The study concluded that shingles is associated with a statistically significant increase in the risk of composite events, TIA, and stroke in adults in the period around diagnosis. Specifically, patients with HZ were more likely to suffer a TIA; the incidence rate ratios (IRRs) for all patients and for patients aged 18 to 49 years were 1.56 and 5.12, respectively. The IRRs for stroke were 1.40 and 8.12.
A 2017 South Korean study published in the Journal of the American College of Cardiology found that shingles raised the risk of a composite of cardiovascular events including heart attack and stroke by 41%, the risk of stroke by 35%, and the risk of heart attack by 59%. The stroke risk was highest in participants under 40 years old, and the risks of both stroke and heart attack were highest during the first year after the onset of shingles and decreased over time.
Gulati considers community pharmacists to be integral members of the professional healthcare team with a high level of trust, comfort, and access to patients that allows them to take a proactive approach to protecting their patients from shingle’s health risks.
“A pharmacist has the unique ability of knowing everything people are taking, or that they might have hypertension or heart disease based on their medications,” she explains. “They can ask, ‘Have you been vaccinated?’, or give them an information package and say, ‘You might be interested in learning more and making sure your vaccinations are up to date.’ That can at least start the conversation.”