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Shingles Tied to Short-Term Risk for Stroke

RM Shingles


By definition, shingles is an infection of a nerve area caused by the varicella-zoster virus. It causes pain and a rash along a band of skin supplied by the affected nerve. Symptoms usually go within 2-4 weeks. Pain sometimes persists after the rash has gone, more commonly in people over the age of 50.

Seems pretty straight forward right? Well, did you know that you likely already have the virus that causes shingles if you already had chickenpox? Maybe you did – but did you know that the presence of shingles in older patients may put them at greater risk for a stroke? Probably not.

In an ex post facto case-control study, those age 50 and up who had an acute episode of herpes zoster virus were at a significantly increased risk of stroke over the next 3 months compared with controls, Barbara Yawn, MD, of the Olmsted Medical Center in Rochester, Minn., and colleagues reported in the Mayo Clinic Proceedings.

“We’re starting to think that zoster, or shingles, may not be just a neurological disease, but it may be a systemic disease,” Yawn said in a Mayo Clinic Proceedings video interview. “Certainly, those of you who have cared for patients with shingles know they frequently do have systemic symptoms beyond just the localized pain. They have fatigue, myalgias, sometimes low-grade fevers, and other kinds of problems. So zoster may be a systemic illness.”

Earlier studies in Europe and Asia have suggested that patients may be at an increased risk of myocardial infarction (MI) or stroke following shingles, but this risk may be greatest in those under 40, a population in which acute zoster infection isn’t all that common, Yawn went on to say

“In people without a previous MI, there did appear to be an increased risk [of MI following zoster], but it was small, and when you did multiple analyses, it wasn’t robust,” Yawn said. “And when you controlled for all risk factors, it disappeared.”

It is thought that there may be two explanations as to why acute zoster infection increases the risk of stroke. First, the direct effects of the virus on the vasculature, and secondly, the general inflammatory response prompted by infection.

Studies have shown that the virus moves into blood vessels in the central nervous system, which may lead to other changes in the vessel, Yawn said.

“Zoster is not just in the nerves,” she said. “It appears to also affect vascular tissue, and other studies have also said it may be in the gastrointestinal tract as well.”

On the bright side, Yawn noted that the vaccination may prove helpful in diminishing the risk of stroke by preventing the onset of shingles outright. This is yet another reason that anyone who qualifies should take the shingles vaccine, for it might not just help with potential shingles, it could also save your life.