European Primary Care Cardiovascular Society

Herpes zoster enhances risk of stroke and myocardial infarction

Kim M, et al. JACC, 2017

Herpes Zoster Increases the Risk of Stroke and Myocardial Infarction

Kim M,  Yun S, Lee HB, et al.
JACC 2017;70:295-296


The association between herpes zoster and stroke and myocardial infarction (MI) is still unclear. This uncertainty is partly due to the presence of many confounding factors, for which has not been adequately corrected in previous studies.
To take this confounding into account, 519,880 Korean people were followed from 2002 to 2013 to assess the association between newly diagnosed herpes zoster and the composite of stroke and MI, by propensity scoring matching and comprehensive adjustment for confounding.

Main results

  • 4% (23,233 individuals) presented with herpes zoster. Female sex was more common in this group, as were risk factors of stroke and MI, such as old age, hypertension, diabetes, dyslipidemia, angina pectoris, peripheral vascular disease, rheumatoid disease and malignancy.
  • On the other hand, cases with herpes zoster were associated with beneficial medical lifestyles, including less smoking and intake of alcohol, more exercise and a higher representation of economic class.
  • Events of the composite endpoint stroke and MI occurred more frequently in the herpes zoster group than in the non-herpes zoster group (propensity score matching HR 1.41, 95% CI 1.25-1.59, P<0.001). Risk was highest for individuals under the age of 40 (HR 2.42, 95% CI 1.26-4.66, P=0.008) and gradually decreased with age.
  • Absolute incidences were 1.34 per 1000 person-years (95% CI 0.71-1.97) for the herpes zoster group and 0.80 per 1000 person-years (95% CI 0.41-1.18) for the non-herpes zoster group.  
  • Risk of both stroke and MI were highest in the first year after the onset of herpes zoster and tended to decrease with time.


Herpes zoster significantly increased the risk of stroke and MI in all age groups after adjusting for possible confounding factors in a large population cohort. Risks were especially high in the younger who have fewer risk factors for atherosclerosis. Moreover, there was a temporal link between herpes zoster and the development of stroke and MI. 

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