Zoster ups stroke risk in patients with autoimmune disease

05 feb 2017—For patients with autoimmune diseases, the risk of stroke is increased in the few months subsequent to incident herpes zoster (HZ), according to a study published online Jan. 28 in Arthritis & Rheumatology.

Leonard H. Calabrese, D.O., from the Cleveland Clinic, and colleagues identified patients with autoimmune disease using Medicare data from Jan. 1, 2006, through Dec. 31, 2013. The authors examined whether the incidence of hospitalized stroke was increased immediately following HZ compared with incidence at later time points.
The researchers found that the crude incidence of stroke varied from 2.30 per 100 patient-years (95 percent confidence interval [CI], 0.96 to 5.52) within 90 days of HZ in patients who had HZ-related cranial nerve complications and did not receive treatment, to 0.87 per 100 patient-years (95 percent CI, 0.75 to 1.02) at 366 to 730 days for those who did not have complications and who received treatment. The overall incidence rate ratio (IRR) was 1.36 (95 percent CI, 1.10 to 1.68) for stroke in the first 90 days versus at 366 to 730 days after HZ, after multivariable adjustment for multiple stroke-related factors. Patients with zoster and cranial nerve complications had greater risk (IRR, 2.08; 95 percent CI, 0.99 to 4.36). The incidence of subsequent stroke was lower with prompt antiviral therapy (IRR, 0.83; 95 percent CI, 0.70 to 0.98).
"These data underscore the urgency of developing strategies for reducing the risk of varicella-zoster virus," the authors write.

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