FRIDAY, Jan. 3, 2014 (HealthDay News) -- People who've had
shingles -- a viral infection also known as herpes zoster -- before
age 40 may have a higher risk of stroke years later, a large new
Adults who get shingles after 40 don't have an increased risk of
stroke. But along with those who had shingles before 40, they do
have a higher risk of heart attack and "transient ischemic attack"
(TIA), sometimes called a mini-stroke, the study authors said.
"In those aged less than 40 years at the time of herpes zoster, the risk of stroke, TIA and [heart attack] occurring in the years following was significantly higher than in [people without the infection]," said Dr. Judith Breuer, study lead author and a professor of virology and head of infection and immunity at University College London, in England.
"Herpes zoster is also more common in individuals who have risk factors for vascular disease, including diabetes and [high blood pressure]," Breuer said.
While the study found a link between shingles and higher stroke
risk in younger adults, it didn't prove a cause-and-effect
Results of the study appeared online Jan. 2 in advance of
publication in the Jan. 21 print issue of the journal
Shingles is caused by the same virus that causes chickenpox.
After someone has chickenpox, the virus stays in the body, lying
dormant in the nerve roots, often for decades. It's not clear
exactly why, but in some people, the virus reactivates and causes
shingles, according to the U.S. Centers for Disease Control and
People who have compromised immune systems are more likely to
have shingles, according to the CDC. This includes people who have
HIV and certain cancers, and people taking medications that
suppress the immune system, such as those who've had an organ
Shingles causes a painful rash, usually on one side of the body.
Pain, itching and tingling may occur before the rash appears.
Stroke risk is increased during a bout of shingles, according to
background information in the study. But, Breuer and her colleagues
wondered if the increased stroke risk lasted much longer than the
To answer that question, they reviewed more than 106,000 cases
of shingles in the United Kingdom and compared them to more than
213,000 people who were matched for age and sex but hadn't had
shingles. For those who'd had shingles, the average time since
their illness was a little over six years. The longest time since
shingles was 24 years.
The researchers controlled their analysis to account for other
factors that could increase stroke and heart attack risk, such as
smoking history, high blood pressure, unhealthy cholesterol levels,
diabetes, heart problems and obesity.
In people who'd had shingles when they were over 40, the risk of
stroke was not increased, the investigators found. However, the
risks of heart attack and mini-strokes were slightly higher.
For those who had shingles before age 40, however, risk of
stroke was 74 percent higher compared to those who hadn't had
shingles. Their risk of mini-stroke was 2.4 times higher and their
risk of heart attack was increased by 50 percent, the study
Breuer said the reason that having had shingles might increase a
person's risk of stroke, mini-stroke or heart attack is that
shingles can also cause an inflammation of certain blood vessels.
In people who already have risk factors for stroke or heart attack,
this inflammation would add to that risk, she explained.
However, two U.S. doctors suggested that stroke risk posed by
shingles might be overstated.
"The risk may be higher in people under 40 because of all the confounding factors they looked at," said Dr. Kenneth Bromberg, director of the Vaccine Research Center at the Brooklyn Hospital Center in New York City. "Maybe more attention is paid to factors like diabetes and [high blood pressure] in people over 40. Maybe if you deal with the risk factors, the zoster might be less of an issue."
Added Dr. Len Horovitz, an internal medicine physician at Lenox
Hill Hospital in New York City: "Clearly, this study found an
association between stroke and shingles in people under 40, but
it's unclear what the exact mechanism is.
"This study raises more questions than it answers," Horovitz said. "Would these findings be the same in the U.S.? These researchers looked at a British population. Do we need to be more vigilant about screening people who've had early shingles? Is it really a risk factor for stroke? Would the vaccine have any effect?"
Study author Breuer said it's unclear what effect the shingles
vaccine might have on the increased risk of stroke.
In the meantime, all three experts advised that anyone who's had
shingles before age 40 be screened for stroke and heart attack risk
factors, such as diabetes, high blood pressure and unhealthy
Learn more about shingles and the shingles vaccine from the
U.S. Centers for Disease Control and
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