Recombinant Zoster Vaccine Reduces 3-Year Cardiovascular Risk: Insights From a Multi-Centered Database

December 2023 | Volume 22 | Issue 12 | 1178 | Copyright © December 2023


Published online November 15, 2023

Matthew F. Helm MDa, Peter A. Khoury BSb, Haig Pakchanian BSc, Rahul Raiker BSd, Steven Maczuga MSa, Galen T. Foulke MDa

aDepartment of Dermatology, Penn State Health, Hershey, PA
bCollege of Osteopathic Medicine, Kansas City University, Joplin, MO
cSchool of Medicine and Health Science, George Washington University, Washington, DC
dSchool of Medicine, West Virginia University, Morgantown, WV

Abstract
Background: Herpes zoster increases the risk for stroke and myocardial infarction. Zoster vaccination's impact on this risk is understudied. This retrospective work sought to determine if prophylactic herpes zoster vaccination may reduce the risk of stroke, myocardial infarction, and/or mortality.
Methods: A cohort analysis utilized TriNetX, a national, federated database. In one analysis, patients who received 2 doses of recombinant zoster vaccine (RZV) were compared to adults without RZV. A 1:1 propensity-score match analysis was conducted to adjust for demographics and comorbidities in calculating adjusted relative risks (aRR) with 95% confidence intervals. First-time incidences for myocardial infarction, stroke, and mortality were assessed after 3 years. A subgroup analysis between RZV and zoster vaccine live (ZVL) was also assessed.
Results: Matched cohorts of 7,657 patients revealed that adults who received 2 doses of RZV were at lower risk of MI (aRR [95% CI]) = (0.73 [0.55, 0.96]) and mortality (0.7 [0.57, 0.88]) while having similar risk for stroke (0.97 [0.75, 1.26]). Further subgroup analysis also revealed a reduced risk of 3-year mortality when compared to the ZVL cohort (0.84 [0.74, 0.95]). Sample size and comorbidities included in the analysis were limited by using a large database.
Conclusions: RZV reduces the 3-year risk for myocardial infarction and mortality.

J Drugs Dermatol. 2023;22(12):1178-1182. doi:10.36849/JDD.7415

INTRODUCTION

Approximately one in three people within the United States of America (US) will develop herpes zoster in their lifetime.1 Herpes zoster (shingles) is a reactivation of latent varicella-zoster virus (VZV), which is responsible for varicella (chickenpox).2 Zoster is often seen in individuals over 50 or with compromised immune systems.3 Reactivation of VZV manifests as painful rash and potential medical complications such as post-herpetic neuralgia (PHN) and vision loss due to herpes zoster ophthalmicus (HZO) may occur.4

Age and immunosuppression can increase the risk of herpes zoster. In the US, the number of Americans above the age of 60 increased by 34% between 2009 and 2019, and the population aged 65 and older numbered 54.1 million in 2019 (16% of the total population).5 Immunosenescence occurs with aging and correlates to decreased or absent T-lymphocyte response to VZV antigen, increasing the risk of herpes zoster.6 In the US, the incidence of herpes zoster is approximately 4 cases per 1,000 annually and the incidence among people 60 years and older is about 1 case per 100 annually.7 A high incidence of herpes zoster has also been reported in immunocompromised or immunosuppressed patients of any age.8,9 

Studies report that herpes zoster increases the risk of cardiovascular and cerebrovascular events, including stroke and myocardial infarction.10-12 Herpes zoster vaccination's impact on these events is understudied. Given the growing population at risk for herpes zoster reactivation and the reported relationship between herpes zoster and other health issues, prevention is important to boost VZV-specific immunity.
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