Herpes Zoster and Transient Cardiovascular Vulnerability: Mechanisms and Implications for Vaccination
Year: 2026
Type: article
Abstract: Herpes zoster (HZ), commonly known as shingles, results from reactivation of latent varicella-zoster virus (VZV). Beyond pain and postherpetic neuralgia, HZ is associated with a transient increase in vascular events. This narrative review examines HZ as a vascular trigger, the mechanisms of VZV-associated vascular injury, and the evidence for recombinant zoster vaccine (RZV). Self-controlled studies show that ischemic stroke and myocardial infarction rates peak during the first days to weeks after HZ and decline over subsequent months. Direct arterial infection provides the strongest mechanistic evidence; inflammatory, thrombotic, and autonomic pathways offer additional, less directly established explanations. Randomized trials demonstrate that RZV prevents HZ and postherpetic neuralgia, with sustained protection in long-term follow-up. Associations between vaccination and fewer cardiovascular events derive mainly from observational studies and vary by vaccine platform and endpoint. We use transient post-zoster cardiovascular vulnerability as a clinical framework, not a validated syndrome. Eligible adults should receive RZV for its established prevention benefits, while clinicians should remain alert to new vascular symptoms after HZ. Whether RZV causally reduces cardiovascular events requires dedicated prospective studies and randomized trials.
Source: Biomolecules
DOI: 10.3390/biom16111634
Institutions: Universitat de València, Instituto de Salud Carlos III, Hospital Clínico Universitario de Valencia, Centro de Investigación en Red en Enfermedades Cardiovasculares, Centro de Investigación Biomédica en Red, INCLIVA Health Research Institute, Valencia Catholic University Saint Vincent Martyr, Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Hospital la Pedrera, Hospital Universitario Virgen Macarena, Hospital General Universitario De Valencia, Universidad de Alcalá, Hospital Universitario Ramón y Cajal
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,258
OpenAlex ID: W7225655972