Association between cardiovascular disease and zoster risk - case-control study in the Clinical Practice Research Datalink

Date of Approval: 
2016-07-28 00:00:00
Lay Summary: 
Three recent studies have suggested a small but increased risk of herpes zoster (more commonly referred to as shingles) among people with a history of cardiovascular disease (for example, heart attacks, strokes and heart failure). The reason for any increased is not understood. We know very little about the impact of cardiovascular disease on shingles and related problems. To answer these questions, I will use a very large general population cohort in the UK. I will identify people with herpes zoster and compare them to people who did not develop herpes zoster and look back in their medical records to see if they had any evidence of cardiovascular disease. I will also adjust for other differences between the groups, including treatments, that might account for any increased risk of shingles. The analysis will help us to understand whether cardiovascular disease or its treatment (in those with established cardiovascular disease) is associated with an increased shingles risk. This study is directly relevant to the NHS as it will help decide who is at risk of shingles and whether specific groups should be targeted for vaccination.
Technical Summary: 
Three recent exploratory studies have suggested a small but increased risk of herpes zoster (or shingles) associated with cardiovascular disease. We have also recently found increased zoster risks in statin users. Our group have also shown a transient increased risk of cardiovascular events (myocardial infarctions and strokes) following zoster. The reasons for increased zoster risks following cardiovascular disease are not understood. Our aim is to investigate the relationship between cardiovascular diseases and risks of zoster and post-herpetic neuralgia (prolonged pain after shingles). We will conduct a matched case-control study: all individuals with an incident zoster diagnosis will be identified and matched on age, sex and GP practice to people who are under follow-up in HES-linked CPRD (using incidence density sampling) at the same time but have no history of zoster. Conditional logistic regression models will be used to examine associations between cardiovascular disease (ischaemic heart disease, myocardial infarction, atrial fibrillation, heart failure and stroke) and zoster, adjusting for a range of potential confounders, including stratifying by statin use. The timing of the relationship between cardiovascular disease and zoster will also be examined. Study findings will have important implications for patients, doctors and will inform vaccination policy.
Health Outcomes to be Measured: 
Cardiovascular diseases (myocardial infarction, any ischaemic heart disease, stroke, heart failure, atrial fibrillation/flutter)
Application Number: 

Sinead Langan - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Sinead Langan - Corresponding Applicant - London School of Hygiene & Tropical Medicine ( LSHTM )
Harriet Forbes - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Liam Smeeth - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )

HES Admitted Patient Care;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation