LOS ANGELES – The prevention of shingles with Zoster Vaccine Live (Zostavax, Merck) may also reduce the risk of subsequent stroke among older adults, the first study suggests to examine this association.
The shingles vaccine was associated with a 20% decrease in the risk of stroke in people under 80 in the large Medicare cohort study. Older participants showed a reduced risk of 10%, according to data published before the formal presentation at the International Conference of Stroke 2020 (ISC) 2020 this week in Los Angeles. Reductions were observed for both ischemic and hemorrhagic events.
“Our findings could encourage people 50 and older to get vaccinated against shingles and prevent the risk of stroke associated with shingles,” Quanhe Yang, PhD, lead author of the study and lead scientist at the Centers for Control and Disease Prevention (CDC) in Atlanta, he told Medscape Medical News.
Quanhe Yang, PhD
Yang and his colleagues evaluated the only vaccine for shingles available at the time of the study, Zoster Vaccine Live, sold under the Zostavax brand. However, the CDC now calls a recombinant non-living adjuvant vaccine (Shingrix, GlaxoSmithKline) the preferred shingles vaccine for healthy adults 50 years of age or older. Shingrix was approved in 2017. Zostavax, approved in 2006, can still be used in healthy adults over 60, according to the agency.
A reduction in the inflammation of Zoster Vaccine Live may be the mechanism by which the risk of stroke is reduced, said Yang. The newer vaccine, which the CDC says is more than 90% effective, could provide even greater protection against stroke, although more research is needed, he added.
Interestingly, previous research suggests that once a person develops shingles, it may be too late. Yang and his colleagues showed that vaccination or antiviral treatment after an episode of shingles was not effective in reducing the risk of stroke in an investigation presented at ISC 2019, as previously reported by Medscape Medical News.
Shingles can present as a painful reactivation of chickenpox, also known as the varicella-zoster virus. Shingles is also common; Yang estimated that 1 in 3 people who had chickenpox will develop the condition at some point in their life. In addition, researchers have linked shingles with a high risk of stroke.
To assess the protective effect of the vaccine on stroke, Yang and his colleagues reviewed the health records of 1.38 million Medicare beneficiaries. All participants were 66 years of age or older, had no history of stroke at the start of the study and received the Zoster Vaccine Live vaccine between 2008 and 2016.
The researchers compared the rate of strokes in this vaccinated group with the rate in a similar control group of the same number of beneficiaries of the Medicare service fee who did not receive the vaccine. They adjusted their analysis by age, sex, race, medications and comorbidities.
The overall 16% decrease in the risk of stroke associated with vaccination included a 12% decrease in hemorrhagic stroke and an 18% decrease in ischemic stroke during a median follow-up of 3.9 years of follow-up. (interquartile range 2.7-5.4).
The adjusted risk ratios that compared the vaccinated groups with the control groups were 0.84 (95% confidence interval (CI), 0.83-0.85) for all strokes; 0.82 (95% CI, 0.81-0.83) for acute ischemic stroke; and 0.88 (95% CI, 0.84 to 0.91) for hemorrhagic stroke.
The vaccinated group experienced 42,267 stroke events during that time. This rate included 33,510 acute ischemic strokes and 4318 hemorrhagic strokes. At the same time, 48,139 strokes occurred in the control group. The breakdown included 39,334 ischemic events and 4713 hemorrhagic events.
“Approximately 1 million people in the United States get shingles every year, however, there is a vaccine to help prevent it,” Yang said in a press release. “The results of our study may encourage people 50 and older to follow the recommendation and get vaccinated against shingles. You are reducing the risk of shingles and, at the same time, may be reducing your risk of stroke.” .
“More studies are needed to confirm our association findings between the Zostavax vaccine and the risk of stroke,” said Yang.
Because the CDC Immunization Practices Advisory Committee (ACIP) only recommended the Shingrix vaccine for healthy adults 50 years of age or older in 2017, there was not enough data in Medicare to study the association between that vaccine and the risk of accident cerebrovascular at the time of the current study.
“However, two doses of Shingrix are more than 90% effective in preventing shingles and postherpetic neuralgia, and are higher than those of Zostavax,” said Yang.
“Very intriguing” research
“This is a very interesting study,” said Ralph L. Sacco, MD, former president of the American Heart Association, in a video comment posted last week before the conference. It was a very large sample, he noted, and those who had the vaccine over age 60 were protected with a lower risk of ischemic and hemorrhagic stroke.
“Therefore, it is very intriguing,” said Sacco, chairman of the department of neurology at the Leonard Miller School of Medicine at the University of Miami in Florida.
“We know that things like shingles can increase inflammation and increase the risk of stroke,” Sacco said, “but this is the first time in a large Medicare database that it was shown that those who had the vaccine had a lower risk of stroke “. “
The Centers for Disease Control and Prevention of the USA. UU. They funded this study. Yang and Sacco have not disclosed relevant financial relationships.
International Stroke Conference (ISC) 2020. Summary TP493. It will be presented on February 20, 2020.
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