913. Increased risks for stroke and acute myocardial infarction after herpes zoster: A population-based propensity score-matched study
Session: Oral Abstract Session: Vaccines, Vaccine Preventable Disease, and their Impact
Friday, October 28, 2016: 9:00 AM
Room: 275-277
Background:Causality between herpes zoster (HZ) and stroke or acute myocardial infarction (AMI) remains uncertain, since confounding factors have not been fully controlled in previous studies. We therefore assessed the risks for stroke and AMI attributed to HZ itself using propensity score-matching analysis.

Methods: The study was based on a prospective cohort from National Health Insurance Service (NHIS) database of South Korea. This cohort consisted of about 570,000 people representing entire population of South Korea, who received a medical check-up and were followed up from 2002 to 2013. We searched the events of HZ, stroke and AMI using the International Classification of Diseases, Tenth Revision(ICD-10) diagnostic codes. The patients with past histories of HZ, stroke or AMI were excluded. We identified a group of HZ patients and a control group of non-HZ patients who were 1:1 matched with each of HZ patients by propensity score. The risks for all cerebro-cardiovascular events, stroke and AMI were analyzed. Furthermore, we performed subgroup analyses according to subtypes of stroke and age groups.

Results: Over 12 years, a total of 519,880 peoples with ≥ 18 years were observed. 23,233 patients were diagnosed with HZ. From the remaining 496,647 without HZ, 23,213 were 1:1 matched with each of HZ patients by propensity score. Two groups of 23,213 subjects with or without HZ finally analyzed. Compared with non-HZ group, HZ group had significantly higher risks for all cerebro-cardiovascular events, stroke and AMI: hazard ratios (HR) were, respectively, 1.41 (95% CI, 1.25-1.59) (P < 0.001), 1.35 (95% CI, 1.18-1.54) (P < 0.001), and 1.59 (95% CI, 1.27-2.01) (P< 0.001). In subgroup analyses, HR for hemorrhagic stroke and ischemic stroke were 1.66 and 1.25, respectively. Notably, risks for stroke after HZ gradually decreased according to aging: HR 3.74 in ≤ 40 years, HR 1.49 in 41 to 50 years, HR 1.39 in 51 to 60 years, HR 1.25 in 61 to 70 years, HR 1.24 in ≥ 71 years. However, risk for AMI after HZ peaked in 51 to 60 years: HR 1.45 in ≤ 40 years, HR 1.47 in 41 to 50 years, HR 1.96 in 51 to 60 years, HR 1.24 in 61 to 70 years, HR 1.91 in ≥ 71 years.

Conclusion: Our findings showed the increased risks for both stroke and AMI after HZ, by which the causality between them could become highly plausible.

Min-Chul Kim, MD1, Sung-Cheol Yun, PhD2, Sun U. Kwon, MD3, Han-Bin Lee, MD3, Pil Hyung Lee, MD4, Seung-Whan Lee, MD4, Sang-Oh Lee, MD5, Sang-Ho Choi, MD5, Yang Soo Kim, MD5, Jun Hee Woo, MD5 and Sung-Han Kim, MD5, (1)Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, The Republic of, (2)Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, The Republic of, (3)Departments of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, The Republic of, (4)Departments of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, The Republic of, (5)Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, The Republic of

Disclosures:

M. C. Kim, The National Research Foundation (NRF) funded by the Ministry of Education, Science and Technology: Grant Investigator , Research grant

S. C. Yun, None

S. U. Kwon, None

H. B. Lee, None

P. H. Lee, None

S. W. Lee, None

S. O. Lee, None

S. H. Choi, None

Y. S. Kim, None

J. H. Woo, None

S. H. Kim, The National Research Foundation (NRF) funded by the Ministry of Education, Science and Technology: Grant Investigator , Research grant

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