Xu Xinyi, Ray Isabel, Tang Emily, Arnold Benjamin F, Acharya Nisha R
F.I. Proctor Foundation, University of California, San Francisco, California, USA.
Department of Ophthalmology, University of California, San Francisco, California, USA.
J Infect Dis. 2025 Aug 14;232(2):465-473. doi: 10.1093/infdis/jiaf105.
Herpes zoster (HZ) is associated with a higher risk of cardiovascular events, but the effect of the recombinant zoster vaccine (RZV) on this risk, alone or in combination with antiviral treatment, remains uncertain. The aim of this study was to evaluate the impact of RZV on the risk of cardiovascular disease (CVD) events following HZ infection.
We conducted a retrospective cohort study using the Optum Labs Data Warehouse. Adults aged ≥50 years with HZ diagnosed between 1 January 2018 and 31 March 2023 were included. Participants were categorized by their receipt of RZV and antiviral treatment for HZ. A Cox multivariable proportional hazards model estimated the association with post-HZ cardiovascular events.
Among 112 637 patients with HZ, 5240 (4.7%) received both RZV and antiviral therapy, 2644 (2.3%) received RZV alone, 80 871 (71.8%) received antiviral therapy alone, and 23 882 (21.2%) received neither. RZV alone reduced the CVD risk by 21% (95% confidence interval, 6%-33%), antiviral therapy alone by 22% (16%-26%), and receipt of both by 39% (28%-47%).
This study underscores the effectiveness of RZV and antiviral therapy in mitigating cardiovascular risks after HZ infection. Having both preventive vaccination and therapeutic antiviral intervention may offer enhanced protection against CVD and death.
带状疱疹（HZ）与心血管事件风险较高相关，但重组带状疱疹疫苗（RZV）对该风险的影响，单独使用或与抗病毒治疗联合使用时，仍不确定。本研究的目的是评估RZV对HZ感染后心血管疾病（CVD）事件风险的影响。
我们使用Optum Labs数据仓库进行了一项回顾性队列研究。纳入了2018年1月1日至2023年3月31日期间诊断为HZ的年龄≥50岁的成年人。参与者根据其是否接受RZV和针对HZ的抗病毒治疗进行分类。Cox多变量比例风险模型估计了与HZ后心血管事件的关联。
在112637例HZ患者中，5240例（4.7%）接受了RZV和抗病毒治疗，2644例（2.3%）仅接受了RZV，80871例（71.8%）仅接受了抗病毒治疗，23882例（21.2%）两者均未接受。仅RZV可将CVD风险降低21%（95%置信区间，6%-33%），仅抗病毒治疗可降低22%（16%-26%），两者均接受可降低39%（28%-47%）。
本研究强调了RZV和抗病毒治疗在减轻HZ感染后心血管风险方面的有效性。进行预防性疫苗接种和治疗性抗病毒干预可能会提供更强的针对CVD和死亡的保护。
