In a groundbreaking observational study recently published in the European Heart Journal, researchers have provided compelling evidence that vaccination against shingles may extend protective benefits well beyond the prevention of the painful viral rash. An extensive analysis involving over 1.2 million individuals aged 50 and above in South Korea revealed that recipients of the live zoster vaccine experienced a significant 23% reduction in the risk of various cardiovascular events. These include stroke, heart failure, and coronary heart disease, all of which carry substantial morbidity and mortality worldwide.
The study, which tracked participants over a period beginning in 2012 and extending up to 12 years, meticulously linked vaccination status with comprehensive cardiovascular health records. This data was further adjusted for confounding variables such as age, sex, socioeconomic status, and lifestyle factors including smoking, alcohol consumption, and physical activity levels. One of the most striking findings was that the protective cardiovascular effect of the vaccine was most prominent in the two to three years following immunization, yet the benefit appeared to endure for as long as eight years post-vaccination.
The live zoster vaccine used in this investigation contains an attenuated form of the varicella zoster virus (VZV), which reactivates later in life to cause shingles. This recombinant live virus serves to stimulate an immune response capable of not only preventing shingles but, according to the study’s findings, also mitigating systemic inflammatory processes linked to cardiovascular pathology. Professor Dong Keon Yon, the lead investigator from Kyung Hee University College of Medicine in Seoul, emphasized that shingles itself is known to provoke vascular inflammation, endothelial damage, and prothrombotic states—all factors intricately connected to cardiovascular disease onset and progression.
Particularly compelling was the observation that vaccine recipients under the age of 60 and males garnered a more pronounced decrease in cardiovascular risk, potentially reflecting differential immune responses or biological susceptibilities in these subgroups. Equally noteworthy was the enhanced protective effect seen in individuals with typically higher risk lifestyles, such as tobacco users and those leading sedentary lives, suggesting that shingles vaccination could be a strategic intervention even among those with established cardiovascular risk factors.
Historically, the link between herpes zoster and cardiovascular disease has been acknowledged, yet the causative and protective mechanisms had remained elusive. This large-scale cohort study, representing one of the most robust and comprehensive efforts to date, advances the concept that vaccination may interrupt the pathophysiological cascade initiated by VZV reactivation. By preventing shingles, the vaccine may reduce the chronic inflammatory burden and vascular injury that predispose to atherosclerosis and cardiac events.
It is important to highlight that the study’s use of an Asian population cohort might limit the immediate generalizability of its findings to broader, ethnically diverse populations. Nonetheless, the extensive sample size and duration provide a compelling foundation for the hypothesis that shingles vaccination exerts cardiovascular benefits. Additionally, since the live zoster vaccine is contraindicated in certain groups, such as immunocompromised individuals, further investigation into the recombinant non-live zoster vaccine—now widely implemented in many countries—is essential to understand whether similar cardiovascular protective effects are observed.
The research team underscores that despite the observed associations, their study cannot definitively establish causality, as residual confounding factors and biases inherent to observational designs cannot be fully excluded. However, their rigorous adjustment for multiple potential confounders and the dose-response-like pattern seen with the duration of vaccine efficacy strengthen confidence in the observed link.
From a mechanistic perspective, VZV infection is suspected to trigger endothelial dysfunction and inflammatory cascades capable of disrupting the delicate equilibrium of vascular homeostasis. These pathological processes include direct viral invasion of blood vessel walls and induction of a pro-inflammatory milieu conducive to thrombus formation and plaque instability—hallmarks of cardiovascular events such as myocardial infarction and stroke. Therefore, immunization against VZV may effectively reduce these insults, thereby lowering the incidence of subsequent cardiovascular morbidity.
The potential public health implications of these findings are profound. Given the global burden of cardiovascular diseases and the increasing prevalence of shingles in aging populations, integrating shingles vaccination into preventive cardiology protocols could represent a novel strategy to curb cardiovascular risk. Moreover, this approach leverages an existing approved vaccine, potentially enabling rapid translation into clinical practice.
Professor Yon and colleagues plan to extend their research by examining the impact of the recombinant zoster vaccine on cardiovascular outcomes. Considering that the recombinant vaccine represents the current standard in many regions due to an improved safety profile in immunocompromised patients, confirmation of cardiovascular benefits with this vaccine could further revolutionize preventive strategies.
In conclusion, this landmark study advances understanding of the interconnectedness between infectious diseases and chronic non-communicable diseases. It opens new avenues for interdisciplinary approaches combining immunization with cardiovascular risk reduction, a field traditionally dominated by lipid management and lifestyle modification. While future randomized controlled trials are necessary to establish direct causation, the current evidence strongly supports shingles vaccination as a potentially valuable tool in comprehensive cardiovascular disease prevention.
—
Subject of Research: People
Article Title: Live zoster vaccination and cardiovascular outcomes: a nationwide, South Korean study
News Publication Date: 6-May-2025
Web References: http://dx.doi.org/10.1093/eurheartj/ehaf230
References: European Heart Journal, DOI 10.1093/eurheartj/ehaf230
Keywords: Vaccination, Cardiology, Cardiovascular disorders, Cardiac arrest, Heart failure, Ischemia
