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January 21, 2014; 82 (3) ArticleOpen Access

Herpes zoster as a risk factor for stroke and TIA

A retrospective cohort study in the UK

Judith Breuer, Maud Pacou, Aline Gauthier, Martin M. Brown
First published January 2, 2014, DOI: https://doi.org/10.1212/WNL.0000000000000038
Judith Breuer
From the Division of Infection and Immunity (J.B.), and Institute of Neurology (M.M.B.), University College London; and Amaris (M.P., A.G.).
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Maud Pacou
From the Division of Infection and Immunity (J.B.), and Institute of Neurology (M.M.B.), University College London; and Amaris (M.P., A.G.).
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Aline Gauthier
From the Division of Infection and Immunity (J.B.), and Institute of Neurology (M.M.B.), University College London; and Amaris (M.P., A.G.).
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Martin M. Brown
From the Division of Infection and Immunity (J.B.), and Institute of Neurology (M.M.B.), University College London; and Amaris (M.P., A.G.).
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Citation
Herpes zoster as a risk factor for stroke and TIA
A retrospective cohort study in the UK
Judith Breuer, Maud Pacou, Aline Gauthier, Martin M. Brown
Neurology Jan 2014, 82 (3) 206-212; DOI: 10.1212/WNL.0000000000000038

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This article has corrections. Please see:

  • Herpes zoster as a risk factor for stroke and TIA: A retrospective cohort study in the UK - June 17, 2014
  • EDITORIAL EXPRESSION OF CONCERN: Herpes zoster as a risk factor for stroke and TIA: A retrospective cohort study in the UK - February 05, 2014
  • Herpes zoster as a risk factor for stroke and TIA - July 08, 2014
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Abstract

Objectives: Stroke and TIA are recognized complications of acute herpes zoster (HZ). In this study, we evaluated HZ as a risk factor for cerebrovascular disease (stroke and TIA) and myocardial infarction (MI) in a UK population cohort.

Methods: A retrospective cohort of 106,601 HZ cases and 213,202 controls matched for age, sex, and general practice was identified from the THIN (The Health Improvement Network) general practice database. Cox proportional hazard models were used to examine the risks of stroke, TIA, and MI in cases and controls, adjusted for vascular risk factors, including body mass index >30 kg/m2, smoking, cholesterol >6.2 mmol/L, hypertension, diabetes, ischemic heart disease, atrial fibrillation, intermittent arterial claudication, carotid stenosis, and valvular heart disease, up to 24 years (median 6.3 years) after HZ occurrence.

Results: Risk factors for vascular disease were significantly increased in cases of HZ compared with controls. Adjusted hazard ratios (AHRs) for TIA and MI but not stroke were increased in all patients with HZ (AHR [95% confidence interval]: 1.15 [1.09–1.21] and 1.10 [1.05–1.16], respectively). However, stroke, TIA, and MI were increased in cases whose HZ occurred when they were younger than 40 years (AHR [95% confidence interval]: 1.74 [1.13–2.66], 2.42 [1.34–4.36], 1.49 [1.04–2.15], respectively). Subjects younger than 40 years were significantly less likely to be asked about vascular risk factors than were older patients (p < 0.001).

Conclusion: HZ is an independent risk factor for vascular disease in the UK population, particularly for stroke, TIA, and MI in subjects affected before the age of 40 years. In older subjects, better ascertainment of vascular risk factors and earlier intervention may explain the reduction in risk of stroke after the occurrence of HZ.

GLOSSARY

AHR=
adjusted hazard ratio;
BMI=
body mass index;
GP=
general practitioner;
HR=
hazard ratio;
HZ=
herpes zoster;
HZO=
herpes zoster ophthalmicus;
ICD=
International Classification of Diseases;
MI=
myocardial infarction;
THIN=
The Health Improvement Network;
VZV=
varicella-zoster virus

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at www.neurology.org

  • Received June 6, 2013.
  • Accepted in final form October 8, 2013.
  • © 2014 American Academy of Neurology

This is an open access article distributed under the terms of the Creative Commons Attribution-Noncommercial No Derivative 3.0 License, which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially.

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  • Herpes zoster as a risk factor for stroke and TIA: A retrospective cohort study in the UK
  • EDITORIAL EXPRESSION OF CONCERN: Herpes zoster as a risk factor for stroke and TIA: A retrospective cohort study in the UK
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