Herpes Zoster and Vascular Risk

  • Charlotte Warren-GashEmail author
  • Judith Breuer


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.


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



Acute ischaemic stroke


Confidence interval


Clinical Practice Research Datalink


Electronic health record


Hazard ratio


Herpes zoster


Herpes zoster ophthalmicus


Incidence ratio


Incidence rate ratio


Myocardial infarction


Peripheral vascular disease


Subarachnoid haemorrhage


Simian varicella virus


The Health Improvement Network


Transient ischaemic attack


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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