Protective Effects of Recombinant Zoster Vaccine and Antiviral Therapy Against Cardiovascular Disease Following Herpes Zoster Infection.

Background: Herpes zoster (HZ) is associated with a higher risk of cardiovascular events, but the effect of the recombinant zoster vaccine (RZV) on this risk, alone or in combination with antiviral treatment, remains uncertain. The aim of this study was to evaluate the impact of RZV on the risk of cardiovascular disease (CVD) events following HZ infection.

Methods: We conducted a retrospective cohort study using the Optum Labs Data Warehouse. Adults aged 50 years or older with HZ diagnosed between January 1, 2018 and March 31, 2023 were included. Participants were categorized by their receipt of RZV and antiviral treatment for HZ. A Cox multivariable proportional hazards model estimated the association with post-HZ cardiovascular events.

Results: Among 112,637 HZ patients, 5,240 (4.7%) received both RZV and antiviral therapy, 2,644 (2.3%) received only RZV, 80,871 (71.8%) received only antiviral therapy, and 23,882 (21.2%) received neither. RZV alone reduced CVD risk by 21% (95% CI, 6%-33%), antiviral therapy alone by 22% (95% CI, 16%-26%), and receipt of both RZV and antiviral treatment by 39% (95% CI, 28%-47%).

Conclusions: This study underscores the effectiveness of RZV and antiviral therapy in mitigating cardiovascular risks post-HZ infection. Having both preventive vaccination and therapeutic antiviral intervention may offer enhanced protection against CVD and mortality.