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

Date of Approval
Application Number
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)


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