A systematic review and meta-analysis on herpes zoster and the risk of cardiac and cerebrovascular events

Background
Patients who develop herpes zoster or herpes zoster ophthalmicus may be at risk for cerebrovascular and cardiac complications. We systematically reviewed the published literature to determine the association between herpes zoster and its subtypes with the occurrence of cerebrovascular and cardiac events.
Methods/Results
Systematic searches of PubMed (MEDLINE), SCOPUS (Embase) and Google Scholar were performed in December 2016. Eligible studies were cohort, case-control, and self-controlled case-series examining the association between herpes zoster or subtypes of herpes zoster with the occurrence of cerebrovascular and cardiac events including stroke, transient ischemic attack, coronary heart disease, and myocardial infarction. Data on the occurrence of the examined events were abstracted. Odds ratios and their accompanying confidence intervals were estimated using random and fixed effects models with statistical heterogeneity estimated with the I2 statistic. Twelve studies examining 7.9 million patients up to 28 years after the onset of herpes zoster met our pre-defined eligibility criteria. Random and fixed effects meta-analyses showed that herpes zoster, type unspecified, and herpes zoster ophthalmicus were associated with a significantly increased risk of cerebrovascular events, without any evidence of statistical heterogeneity. Our meta-analysis also found a significantly increased risk of cardiac events associated with herpes zoster, type unspecified.
Conclusions
Our results are consistent with the accumulating body of evidence that herpes zoster and herpes zoster ophthalmicus are significantly associated with cerebrovascular and cardiovascular events.

背景
罹患带状疱疹（herpes zoster）或眼带状疱疹（herpes zoster ophthalmicus）的患者，可能面临脑血管与心脏并发症风险。本研究通过系统回顾已发表文献，旨在明确带状疱疹及其亚型与脑血管及心脏不良事件发生的关联。

方法与结果
本研究于2016年12月对PubMed（MEDLINE）、Scopus（Embase）及谷歌学术（Google Scholar）进行系统检索。纳入的研究类型包括队列研究、病例对照研究及自身对照病例系列研究，旨在探讨带状疱疹或其亚型与脑血管及心脏不良事件的关联，所考察的事件包括脑卒中（stroke）、短暂性脑缺血发作（transient ischemic attack）、冠心病（coronary heart disease）及心肌梗死（myocardial infarction）。研究人员提取了所考察事件的发生数据，采用随机效应模型与固定效应模型估算比值比（odds ratios）及其伴随的置信区间（confidence intervals），并通过I²统计量（I2 statistic）评估统计学异质性。共有12项研究符合我们预先设定的纳入标准，这些研究共覆盖了带状疱疹发病后最长达28年的790万例患者。随机与固定效应荟萃分析（meta-analyses）结果显示，未分型带状疱疹及眼带状疱疹均与脑血管事件风险显著升高相关，未发现统计学异质性证据。本荟萃分析同时发现，未分型带状疱疹与心脏事件风险显著升高存在关联。

结论
本研究结果与日益增多的研究证据一致，即带状疱疹与眼带状疱疹均与脑血管及心血管事件存在显著关联。