From the Division of Infection and Immunity (J.B.), and Institute of Neurology (M.M.B.), University College London, UK; and Amaris (M.P., A.G.).
Neurology. 2014 Jul 8;83(2):e27-33. doi: 10.1212/WNL.0000000000000584.
Stroke and TIA are recognized complications of acute herpes zoster (HZ). Herein, we evaluate HZ as a risk factor for cerebrovascular disease (stroke and TIA) and myocardial infarction (MI) in a UK population cohort.
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/m(2), smoking, cholesterol >6.2 mmol/L, hypertension, diabetes, ischemic heart disease, atrial fibrillation, intermittent arterial claudication, carotid stenosis, and valvular heart disease, over 24 (median 6.3) years after HZ infection.
Risk factors for vascular disease were significantly increased in cases of HZ compared with controls. Adjusted hazard ratios for TIA and MI but not stroke were increased in all patients with HZ (adjusted hazard ratios [95% confidence intervals]: 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 (adjusted hazard ratios [95% confidence intervals]: 1.74 [1.13-2.66], 2.42 [1.34-4.36], and 1.49 [1.04-2.15], respectively). Subjects younger than 40 years were significantly less likely to be asked about vascular risk factors compared with older patients (p < 0.001).
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 HZ infection.
中风和短暂性脑缺血发作（TIA）是急性带状疱疹（HZ）的公认并发症。在此，我们评估了英国人群队列中 HZ 作为脑血管疾病（中风和 TIA）和心肌梗死（MI）的风险因素。
从 THIN（健康改善网络）普通实践数据库中确定了 106601 例 HZ 病例和 213202 例对照，这些病例和对照按年龄、性别和普通实践相匹配。使用 Cox 比例风险模型检查病例和对照中风、TIA 和 MI 的风险，调整了血管危险因素，包括体重指数（BMI）>30kg/m(2)、吸烟、胆固醇>6.2mmol/L、高血压、糖尿病、缺血性心脏病、心房颤动、间歇性动脉跛行、颈动脉狭窄和心脏瓣膜病，在 HZ 感染后 24 年（中位数 6.3 年）。
与对照组相比，HZ 病例的血管疾病危险因素明显增加。所有 HZ 患者的 TIA 和 MI 调整后的危险比（95%置信区间）均升高（调整后的危险比[95%置信区间]：1.15[1.09-1.21]和 1.10[1.05-1.16]）。然而，HZ 发生在 40 岁以下的病例中，中风、TIA 和 MI 增加（调整后的危险比[95%置信区间]：1.74[1.13-2.66]、2.42[1.34-4.36]和 1.49[1.04-2.15]）。与年龄较大的患者相比，40 岁以下的患者被问及血管危险因素的可能性显著降低（p<0.001）。
HZ 是英国人群血管疾病的独立危险因素，特别是在 40 岁以下受影响的患者中，中风、TIA 和 MI 的风险更高。在年龄较大的患者中，更好地确定血管危险因素并尽早干预可能解释了 HZ 感染后中风风险的降低。
