Association between the risk for cardiovascular events and antiviral treatment for herpes zoster

Background: Cardiovascular risk increases following herpes zoster. We investigated if the treatment with antiviral agents, steroids, and common cardiovascular medications was associated with the risk of postherpetic cardiovascular events.

Methods: This was a nationwide population-based, retrospective, cohort study using the National Health Insurance Service health claims data in Korea. We included patients with a first ever diagnosis of herpes zoster in 2003-2014 and no prior cardiovascular event. Primary outcome was the development of composites of myocardial infarction (ICD-10 code of "I21") and stroke ("I60-63") since the herpes zoster. We analyzed the exposure (intravenous or oral administration) to antiviral agents, steroids, antithrombotics, and statins within ± 7 days from the index date of herpes zoster diagnosis. Follow-up was performed until the development of primary outcome, death, or December 2015.

Results: Of 83,833 patients with herpes zoster, the proportion of patients who received the treatment with antiviral agents, steroids, antithrombotics, and statins were 90.5%, 48.0%, 9.0%, and 7.9%, respectively. During the 5.4 ± 3.1 years of mean follow-up period, 1,306 patients suffered the primary outcome. Multivariate Cox regression analysis demonstrated that treatment with antiviral agents (adjusted HR, 0.80; 95% CI, 0.69-0.93) and statins (adjusted HR, 0.67; 95% CI, 0.54-0.82) were significantly associated with the lower risk of primary outcome. Use of antithrombotics and steroids were not associated with the risk.

Conclusions: After herpes zoster, treatment with antiviral agents was significantly associated with lower risk of cardiovascular events. We need more information on the cardiovascular protective role of the herpes zoster treatments.

Keywords: antiviral; cardiovascular; herpes zoster; statin; varicella.