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Herpes Zoster and Vascular Risk

  • Charlotte Warren-Gash
  • Judith Breuer
Chapter

Abstract

Herpes zoster or shingles results from reactivation of varicella zoster virus, usually due to a decline in cell-mediated immunity with age or immunosuppression. Although the commonest complication is post-herpetic neuralgia, herpes zoster has increasingly been associated with vascular complications. Several large epidemiological studies using electronic health records in different European and Asian populations have found an association between herpes zoster and increased risk of stroke in the following months. A similar transient increase in the risk of myocardial infarction has been shown after herpes zoster in two UK studies. There are likely to be several mechanisms underlying the relationship between infections such as herpes zoster and acute vascular events. Infections in general induce inflammation which can lead to endothelial dysfunction and promote a pro-coagulant state. For herpes zoster specifically, VZV vasculopathy is likely to be a key contributor to vascular complications affecting the central nervous system. This infiltrative disorder of vessel walls is associated with productive VZV replication in arteries that results in pathological vascular remodelling. Typically early adventitial infection occurs, after which the virus spreads through the media towards the lumen. Disruption of smooth muscle cells in the media affects the risk of aneurysm formation, while intimal thickening contributes to vascular occlusion and ischaemia. Improved identification of populations at risk from vascular complications following shingles and better understanding of the timing and nature of this relationship will be essential to target interventions effectively.

Keywords

Herpes zoster Herpes zoster ophthalmicus Shingles Varicella zoster virus Stroke Transient ischaemic attack Myocardial infarction Acute coronary syndrome Cardiovascular Cerebrovascular Vasculopathy 

Abbreviations

AIS

Acute ischaemic stroke

CI

Confidence interval

CPRD

Clinical Practice Research Datalink

EHR

Electronic health record

HR

Hazard ratio

HZ

Herpes zoster

HZO

Herpes zoster ophthalmicus

IR

Incidence ratio

IRR

Incidence rate ratio

MI

Myocardial infarction

PVD

Peripheral vascular disease

SAH

Subarachnoid haemorrhage

SVV

Simian varicella virus

THIN

The Health Improvement Network

TIA

Transient ischaemic attack

VZV

Varicella zoster virus

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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Institute of Health InformaticsUniversity College LondonLondonUK
  2. 2.Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUK
  3. 3.Division of Infection & ImmunityUniversity College LondonLondonUK

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