Herpes Zoster and Cardiovascular Risk: Current Evidence and Clinical Perspectives

Abstract

Herpes zoster results from the reactivation of latent varicella-zoster virus in sensory ganglia and is more prevalent among older adults and immunocompromised individuals. Recent evidence has demonstrated an association between herpes zoster infection and an increased risk of cardiovascular events, which remains underrecognized in clinical practice. To analyze current scientific evidence regarding the relationship between herpes zoster and cardiovascular risk, with emphasis on the main associated events and clinical implications. This is an integrative literature review conducted through searches in the PubMed, Scopus, and Web of Science databases, including studies published in recent years. Observational studies, cohort studies, and systematic reviews evaluating the association between herpes zoster, vaccination, antiviral treatment, and cardiovascular events were included. Duplicate articles, case reports, and studies lacking relevant clinical data were excluded. The analyzed studies demonstrated a significant increase in the risk of cardiovascular events, particularly stroke, transient ischemic attack, acute myocardial infarction, and coronary artery disease, especially within the first year after viral reactivation. Herpes zoster ophthalmicus showed an even stronger association with these outcomes. Additionally, evidence indicates that herpes zoster vaccination is associated with a reduced risk of stroke, whereas antiviral treatment did not consistently demonstrate a statistically significant reduction in this risk. Herpes zoster infection is associated with an increased cardiovascular risk, highlighting the need for greater clinical surveillance, particularly in the post-infection period. Vaccination emerges as a potentially protective strategy, while the lack of specific guidelines underscores the importance of further research to guide prevention and management of these patients.