Table 4.
Summary of Studies Assessing risk of stroke or MI after zoster
| Author, year, country |
Design | Population | Sample size | Stroke/TIA— short-term results |
Stroke/TIA— long-term results |
MI—short- term results |
MI—long-term results |
|---|---|---|---|---|---|---|---|
| Breuer et al., 2014, UK | Matched cohort—age, sex and practice site Zoster from administrative data Follow-up Mean, 6.8 years (range 1 – 24 years) |
All ages, attending GP offices Zoster from administrative data 2002–2010 |
106,601 cases 213,202 controls Mean age, 57.8 years |
NA | Cox proportional hazard ratios Older (>40 years) TIA---HR = 1.15 (1.09–1.21) Stroke—not significant Younger (<40 years) Stroke---HR 2.42 (1.34–4.36) TIA--- HR 1.49 (1.04–2.15) |
NA | Cox proportional hazard ratios Older (>40 years) MI---HR = 1.10 (1.05–1.16) Younger (≤40 years) MI----HR 1.74 (1.13–2.66) |
| Kang et al., 2009, Taiwan | Case and control cohorts, age- and sex-matched Zoster from administrative data |
Adults 18+ Zoster from administrative data 1997–2001 |
7,760 cases 23,800 controls Mean age, 46.7 years |
Kaplan-Meier and log rank test Stroke and TIA combined All ages: Crude--I year HR 1.31 (1.07–1.61) Adjusted--1 year HR 1.31 (1.06–1.60) |
NA | NA | NA |
| Langan et al., 2014, UK | Cohort comparing individual in year before zoster with year after. Zoster from adminis-trative data |
Adults 18+ Zoster from administrative data 1987–2012 |
6,584 eligible cases who served as their own controls Mean age at stroke, 77 years |
Conditional Poisson regression, incidence rate ratios (IRR) All ages: 1–4 weeks, IRR 1.63 (1.32–2.02) 5–12 weeks, IRR 1.42 (1.21–1.68) 13–26 weeks, IRR 1.23 (1.07–1.42) 27–52 weeks, not significant |
NA | NA | NA |
| Lin et al, 2010, Taiwan | Case and control cohorts, age by decade and sex-matched HZO from medical record review |
Adults 18+ Zoster from administrative data 2003–2004 |
658 cases with HZO 1,974 controls without zoster Mean age 56.9 years |
Kaplan-Meier log rank test Stroke All ages: Crude HR 5.15 (3.31–8.33) Adjusted HR 4.52 (2.40–11.10) |
NA | NA | NA |
| Sreenivasan et al, 2013, Denmark | Cohort “Exposed” presumed zoster—prescribed antiviral therapy | Adults 18+ Zoster from antiviral proxy 1995– 2008 |
4.6 million cohort 117, 926 zoster cases Mean age – not reported |
Poisson regression incident rate ratios (IRR) All ages: 2 weeks IRR, 2.27 (1.83–2.82) [no difference in age groups] 1 year IRR, 1.17 (1.09–1.24) [risk in younger than 40 years—p .0002] |
Poisson regression incident rate ratios (IRR): Stroke and TIA combined All ages: >1 year IRR, 1.05 (1.02–1.09) [not significant in >60 years] |
NA | NA |
| Yawn et al., 2015, US | Case/control, age-and sex-matched in same geographic area Zoster confirmed by medical records Mean follow-up, 7.1 years (range 0 – 28 years) |
Adults 50+ Zoster confirmed by medical records 1986–2010 |
4,862 zoster cases 19,433 control patients Mean age, 68.1 years |
Multivariate logistic regression ≥ 50 years: 3 months OR 1.53 (1.10–2.33) 6, 9, 12 and 36 months—not significant |
Kaplan Meier ≥ 50 years: HR 1.11 (1.10–1.22) Not significant when accounting for multiple risk factors |
Multivariate logistic regression ≥ 50 years: 3 months 1.68 (1.03–2.75) 6, 9, 12 and 36 months--not significant |
Kaplan Meier ≥ 50 years: HR 1.13 (1.01–1.27) Not significant when accounting for multiple risk factors |