UMMS Affiliation

Department of Quantitative Health Sciences; Lamar Soutter Library; Division of Infectious Diseases and Immunology, Department of Medicine; Division of General Internal Medicine, Department of Medicine; Department of Family Medicine and Community Health

Publication Date


Document Type



Cardiology | Cardiovascular Diseases | Infectious Disease | Library and Information Science | Virus Diseases


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.


Herpes Zoster, Cerebrovascular Disorders, Systematic Review

Rights and Permissions

Copyright: © 2017 Erskine et al.

DOI of Published Version



Erskine N, Tran H, Levin L, Ulbricht C, Fingeroth J, Kiefe C, Goldberg RJ, Singh S. A systematic review and meta-analysis on herpes zoster and the risk of cardiac and cerebrovascular events. PLoS One. 2017 Jul 27;12(7):e0181565. doi: 10.1371/journal.pone.0181565. eCollection 2017. Link to article on publisher's website

Journal/Book/Conference Title

PLoS One

Related Resources

Link to article in PubMed

PubMed ID


Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

journal.pone.0181565.s001.pdf (161 kB)
S1 Checklist. PRISMA checklist.

journal.pone.0181565.s002.pdf (17 kB)
S1 File. Appendix I: Strategy of electronic s20167earches.

journal.pone.0181565.s003.pdf (32 kB)
S2 File. Appendix II: Quality scores for studies included in systematic review and metaanalysis.