title: Risk of stroke and transient ischaemic attack after herpes zoster.
abstract: We assessed the association of herpes zoster (HZ) with stroke/transient ischaemic attack (TIA) in the general population according to age with controlling risk factors for stroke, using a nationwide representative cohort. The study was based on a prospective dynamic cohort consisting of 1 million Koreans representing all age groups, genders and geographical areas in the Korea Health Insurance Database. New events of stroke/TIA and HZ were identified using the diagnostic codes in the International Classification of Diseases, tenth revision. The risk for stroke/TIA after HZ was compared with HZ-free stroke/TIA individuals according to age group. A total of 766 179 adults were followed up for 11 years from 2003. The incidence of the first-diagnosed HZ cases was 9.40 per 1000 person-years, and that of the first-diagnosed stroke/TIA cases was 9.77 per 1000 person-years. The risk for stroke/TIA was higher in patients who had previous HZ episodes than in those who had never experienced HZ (incidence rate ratio 1.90; 95% CI 1.85-1.95). In addition, this risk persisted for several years after HZ. The risk of stroke/TIA after HZ gradually decreased with age; adjusted hazard ratio (HR) 2.04 in 18- to 30-year-olds, HR 1.74 in 30- to 40-year-olds, HR 1.43 in 40- to 50-year-olds, HR 1.23 in 50- to 60-year-olds, HR 1.24 in 60- to 70-year-olds, and HR 1.29 in those >70 years old, after controlling risk factors for stroke/TIA. Our findings provide evidence that HZ carries an increased risk of stroke or TIA and that the effect of HZ on stroke decreases with increasing age.
authors.affiliation: Department of Neurology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: S U
authors.initials: SU
authors.lastname: Kwon
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: S-C
authors.initials: SC
authors.lastname: Yun
authors.affiliation: Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: M-C
authors.initials: MC
authors.lastname: Kim
authors.affiliation: Department of Neurology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: B J
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: Department of Neurology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: S H
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: S-O
authors.initials: SO
authors.lastname: Lee
authors.affiliation: Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: S-H
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Y S
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Woo
authors.affiliation: Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: kimsunghanmd@hotmail.com.
authors.forename: S-H
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006562:Herpes Zoster / Q000150:complications*; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology*; D055815:Young Adult
keywords: Cohort; herpes zoster; shingles; stroke; transient ischaemic attack