Varicella zoster virus and cardiovascular diseases

Human alphaherpesvirus 3
Submitted: August 19, 2022
Accepted: September 3, 2022
Published: September 21, 2022
Abstract Views: 1779
PDF: 708
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


Varicella zoster virus (VZV) is a Herpesviridae family double-stranded DNA virus that only affects humans. The first clinical manifestation appears to be varicella, typical of childhood. VZV, on the other hand, becomes latent in ganglion neurons throughout the neuroaxis after primary infection. The VZV reactivates and travels along peripheral nerve fibers in the elderly and immunocompromised individuals, resulting in Zoster. It can, however, spread centrally and infect cerebral and extracranial arteries, resulting in vasculopathy, which can lead to transient ischemic attacks, strokes, aneurysms, cavernous sinus thrombosis, giant cell arteritis, and granulomatous aortitis. Although the mechanisms of virus-induced pathological vascular remodeling are not fully understood, recent research indicates that inflammation and dysregulation of ligand-1 programmed death play a significant role. Few studies, on the other hand, have looked into the role of VZV in cardiovascular disease. As a result, the purpose of this review is to examine the relationship between VZV and cardiovascular disease, the efficacy of the vaccine as a protective mechanism, and the target population of heart disease patients who could benefit from vaccination.



PlumX Metrics


Download data is not yet available.


Badani H, White T, Schulick N, et al. Frequency of varicella zoster virus DNA in human adrenal glands. J Neurovirol 2016;22:400-2. DOI:
Baudouin E, Lantuejoul P. [Les troublecas moteurs dans le zona].[Article in French]. Gaz Hop 1919;92:1293.
Braun KP, Bulder MM, Chabrier S, et al. The course and outcome of unilateral intracranial arteriopathy in 79 children with ischaemic stroke. Brain 2009;132:544–57. DOI:
Breuer J, Pacou M, Gauthier A, Brown MM. Herpes zoster as a risk factor for stroke and TIA: a retrospective cohort study in the UK. Neurology 2014;82:206-12. DOI:
Burbelo PD, Browne SK, Sampaio EP, et al. Anti- cytokine autoantibodies are associated with opportunistic infection in patients with thymic neoplasia. Blood 2010;116:4848–58. DOI:
Nagel MA, Bubak AN. Varicella zoster virus vasculopathy. J Infect Dis 2018;218:S107-12. DOI:
Nagel MA, Jones D, Wyborny A. Varicella zoster virus vasculopathy: The expanding clinical spectrum and pathogenesis. J Neuroimmunol 2017;308:112-7. DOI:
Cope S, Jones AT. Hemiplegia complicating ophthalmic zoster. Lancet 1954;267:898-9. DOI:
Hashemi N, Zhang J, Volpi J, et al. A pox upon your house. Surv Ophthalmol 2013;58:640–3. DOI:
Filloux F, Townsend J. Herpes zoster ophthalmicus with ipsilateral cerebellar infarction. Neurology 1985;35:1531-2. DOI:
Verghese A, Sugar AM. Herpes zoster ophthalmicus and granulomatous angiitis. An ill-appreciated cause of stroke. J Am Geriatr Soc 1986;34:309-12. DOI:
Liu X, Guan Y, Hou L, et al. The short- and long-term risk of stroke after herpes zoster: a meta-analysis. PLoS One 2016;11:e0165203. DOI:
Yang SY, Li HX, Yi XH, et al. Risk of stroke in patients with herpes zoster: a systematic review and meta-analysis. J Stroke Cerebrovasc Dis 2017;26:301–7. DOI:
Uthman I, Taher A, Khalil I. Hughes syndrome associated with varicella infection. Rheumatol Int 2001;20:167–8. DOI:
Peyton BD, Cutler BS, Stewart FM. et al. Spontaneous tibial artery thrombosis associated with varicella pneumonia and free protein S deficiency. J Vasc Surg 1998;27:563–7. DOI:
Bodensteiner JB, Hille MR, Riggs JE. Clinical features of vascular thrombosis following varicella. Am J Dis Child 1992;146:100–2. DOI:
Erskine N, Tran H, Levin L, et al. A systematic review and meta-analysis on herpes zoster and the risk of cardiac and cerebrovascular events. PLoS One 2017;12:e0181565. DOI:
Seo HM, Cha MJ, Han JH, et al. Reciprocal relationship between herpes zoster and cardiovascular diseases: A nationwide population-based case-control study in Korea. J Dermatol 2018;45:1312-8. DOI:
Warren-Gash C. Herpes zoster: epidemiological links with stroke and myocardial infarction. J Infect Dis 2018;218:S102-6. DOI:
Wang CC, Lin CL, Chang YJ, et al. Herpes zoster infection associated with acute coronary syndrome: a population-based retrospective cohort study. Br J Dermatol 2014;170:1122-9. DOI:
Wu P-H, Chuang Y-S, Lin Y-T. Does Herpes Zooster Increase the risk of stroke and myocardial infarction? A comprehensive review. J Clin Med 2019;8:547. DOI:
Kimberlin DW, Whitley RJ. Varicella-zoster vaccine for the prevention of herpes zoster. N Engl J Med 2007;356:1338-43. DOI:
U.S. Food and Drug Administration. Zostavax. 2006 (package insert). Accessed March 5, 2007. Available from:
Levin MJ, Murray M, Rotbart HA, et al. Immune response of elderly individuals to a live attenuated varicella vaccine. J Infect Dis 1992;166:253-9. DOI:
Schmader KE, Levin MJ, Gnann JW, Jr, et al. Efficacy, safety and tolerability of herpes zoster vaccine in persons aged 50-59 years. Clin Infect Dis 2012;54:922-8 DOI:
James SF, Chahine EB, Sucher AJ, Hanna C. Shingrix: The new adjuvanted recombinant herpes zoster vaccine. Ann Pharmacother 2018;52:673-80. DOI:
European Medicines Agency [Internet]. [Shingrix. Riassunto delle caratteristiche del prodotto].[in Italian]. Available from:
Brisson M, Edmunds WJ, Law B, et al. Epidemiology of varicella zoster infection in Canada and the United Kingdom. Epidemiol Infect 2011;127:305–14. DOI:
Okamoto S, Hata A, Sadaoka K, et al. Comparison of varicella zoster virus specific immunity to patients with diabetes mellitus and healthy individuals. J Infect Dis 2009;200:1606–10. DOI:
Heymann AD, Chodick G, Karpati T, et al. Diabetes as a risk factor for herpes zoster infection: results of a population-based study in Israel. Infection 2008;36:226–30. DOI:
Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005;352:2271-84. DOI:
Arvin AM. Varicella-zoster virus. Clin Microbiol Rev 1996;9:361–81. DOI:
Levin MJ, Smith JG, Kaufhold RM, et al. Decline in varicella-zoster virus (VZV)–specific cell-mediated immunity with increasing age and boosting with a high-dose VZV vaccine. J Infect Dis 2003;188:1336–44. DOI:
Levin MJ, Oxman MN, Zhang JH, et al. Varicella-zoster virus-specific immune responses in elderly recipients of a herpes zoster vaccine. J Infect Dis 2008;197:825–35. DOI:
Yang Q, ChangA, Tong X, Merritt R. Herpes zoster vaccine live and risk of stroke among medicare beneficiaries. Stroke 2021;52:1712-21. DOI:
Ministero della Salute. [Piano Nazionale di Prevenzione Vaccinale 2017-2019.[in Italian]. Available from:
Regione Lombardia. [Le vaccinazioni offerte gratuitamente in Lombardia].[in Italian]. Available from:
Wu P-H, Lin Y-T, Lin C-Y, et al. A nationwide population-based cohort study to identify the correlation between heart failure and the subsequent risk of herpes zoster. BMC Infect Dis 2015;17:17. DOI:
Verschoor CP, Lelic A, Parsons R, et al. Serum C-reactive protein and congestive heart failure as significant predictors of herpes zoster vaccine response in elderly nursing home residents. J Infect Dis 2017;216:191-7. DOI:
Cool CD, Voelkel NF, Bull T. Viral infection and pulmonary hypertension: is there an association? Expert Rev Respir Med 2011;5:207-16. DOI:
Cha M-J, Seo H-M, Choi E-K, et al. Increased risk of atrial fibrillation in the early period after herpes zoster infection: a nationwide population-based case-control study. J Korean Med Sci 2018;33:e160. DOI:

How to Cite

Cersosimo, Angelica, Mauro Riccardi, Ludovica Amore, Giuliana Cimino, Gianmarco Arabia, Marco Metra, and Enrico Vizzardi. 2022. “Varicella Zoster Virus and Cardiovascular Diseases”. Monaldi Archives for Chest Disease 93 (2).