A systematic review in the American Journal of Medicine, published on 4 October, pooled five epidemiological studies, including self-controlled designs, on vascular events after herpes zoster, and reviewed mechanistic work separately.
Stroke showed the most consistent association. Risk was highest in the first weeks to months, peaking about three to four weeks after the rash, and was greater after ophthalmic zoster. Evidence for myocardial infarction and peripheral arterial disease was suggestive but less consistent. Proposed mechanisms include viral vasculopathy, inflammation and thrombosis.
For a physician, this means a patient with recent shingles, especially around the eye, who develops new neurological symptoms deserves a low threshold for stroke assessment. It is also a reason to make sure vascular risk factors are controlled.
The evidence is observational and drawn from only five studies, so it shows a link and a plausible timing, not cause.
- Keep stroke in mind for new neurological symptoms in the month after shingles.
- Treat ophthalmic zoster as the higher-risk form for vascular events.
- Review blood pressure, lipids and antiplatelet needs in older patients with recent zoster.
- Discuss zoster vaccination where it is indicated and available.
Why it matters
It turns a common outpatient infection into a short-term vascular risk window.
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