Shingles and Heart Health

What is shingles?

Shingles is a funny-sounding name for a seriously painful disease.

Also known as herpes zoster, Shingles is an infection that causes a painful rash. It is caused by the varicella-zoster virus (VCV), the same virus that causes chickenpox. After you have chickenpox, the virus stays in your body. As you get older, it may become active again and cause shingles.

Officially, shingles pain can range from mild to severe. The words "itchy" and "burning" frequently come up in descriptions. Some use "horrendous" and "excruciating."

An estimated 1 million people get shingles each year in the United States. Medical experts say that in addition to a rash and pain that can last for weeks, months and sometimes years, shingles also is associated with an increased risk of cardiovascular events such as heart attack and stroke.

Most people who develop shingles only have it one time during their life. However, you can have shingles more than once.

People with shingles most commonly have a rash around the left or right side of the body. Symptoms can include numbness. The rash is usually painful, itchy, or tingly. The face can also be involved; this is known as Ramsay-Hunt syndrome, a complication of VCV and the infection caused by it.

Shingles can lead to serious complications. The most common complication is long-term nerve pain called postherpetic neuralgia, or PHN. This potentially debilitating pain can persist for three months or more. People also can develop eye problems, hearing issues and neurological complications.

After a person has chickenpox, the virus stays in their body for the rest of their life. Most of the time, the immune system keeps the virus at bay, but years and even decades later, the virus may reactivate as shingles.

People who never had chickenpox or didn't get the chickenpox vaccine can get infected with VZV from someone who has shingles, but they would develop chickenpox, not shingles. Another important note: People with chickenpox are more likely to spread VZV than people with shingles.

Am I at risk?

About 1 in 3 people in the U.S. will have shingles in their lifetime, according to the Centers for Disease Control and Prevention.

In most cases, it's not clear what triggers shingles. But some research has linked stress to shingles development. Other research suggests physical trauma is also a risk factor, particularly for shingles that involves the face and head. All of these causes are linked to a weakened immune system.

Conditions that weaken the immune system increase the risk of shingles, as can some drugs, including steroids, that are used to treat autoimmune diseases. Age is the most important risk factor for developing herpes zoster.

You can get shingles if you’ve had direct contact with the fluid from shingles rash blisters. Airborne transmission is uncommon but can occur during close indoor contact.

You cannot get shingles from someone who has shingles. But you can get chickenpox from someone who has shingles if you never had chickenpox or never got the chickenpox vaccine.

More than 99% of Americans born before 1980 had chickenpox, even if they don't remember it. Children can have shingles, but it is not common.

Your risk of shingles and serious complications increases:

• As you get older.
• If you take drugs that keep your immune system from working properly, like steroids and drugs given after an organ transplant.
• If you have medical conditions that keep your immune system from working properly such as certain cancers like leukemia and lymphoma, and HIV infection.

Additionally, any patient who receives selected immunomodulatory therapy, or is treated with chemotherapy and/or corticosteroids, will have immunosuppression.

What are the symptoms of shingles?

The virus usually inflames one or two adjacent clusters of nerves. Shingles most commonly presents as a painful rash that many people describe as a deep burning, throbbing or stabbing sensation.

The rash may look like a stripe or a region of blisters that covers an arm, leg or one side of the face or torso. It can resemble insect bites or other skin conditions. Even a mild case can be extremely painful and debilitating.

If shingles involves the cranial nerves of the head, a person can experience facial paralysis, severe headache, changes in vision or hearing, or other symptoms that could be mistaken for a stroke.

What to expect if you have shingles

If you develop symptoms, see a doctor quickly, the CDC says. Antiviral drugs are most effective within 72 hours of rash onset, though treatment may still be beneficial if new lesions continue to appear.

The rash typically scabs over and clears within two to four weeks. But the pain in the rash area can last about a month. The duration of pain seems to increase with age.

Some people have pain without a rash. In rare cases, people may experience nerve pain without a visible rash, a condition known as zoster sine herpete. Others also develop fever, chills, headache, sensitivity to light, fatigue or upset stomach, sometimes before the rash appears.

What's the link between shingles and cardiovascular issues?

There is a growing body of evidence that links the varicella zoster virus to vascular disease.

In 2022, data from more than 205,000 adults found those who had a history of shingles had a nearly 30% increased risk of experiencing a future cardiovascular event.

The risk for having a stroke was up to 38% higher among people with a history of shingles compared to those without. For coronary heart disease, which included having a heart attack or needing a heart procedure such as a coronary artery bypass graft, the risk was up to 25% higher.

Protect yourself — and others

If you have shingles, you can stop the spread by covering the rash, and avoiding touching or scratching it! You should also wash your hands often for at least 20 seconds. Avoid contact with the following people until your rash scabs over:

• Pregnant women who never had chickenpox or chickenpox vaccine.
• Premature or low-birthweight infants.
• People with weakened immune systems.

Should I get vaccinated against shingles?

The easiest way to protect yourself is to get the vaccine. If you’re 50 or older, the Centers for Disease Control recommends two doses of recombinant zoster vaccine to prevent shingles and related complications.

The vaccine is also recommended for adults 19 and older who have weakened immune systems because of disease or therapy.

Evidence shows the newer shingles vaccine is safe and effective for most people. But you shouldn’t get vaccinated if:

• You have ever had a severe allergic reaction to any component of the vaccine or the vaccine itself.
• You currently have shingles.
• You are pregnant. (You should wait to get the vaccine.)

Some people have soreness, redness, swelling or pain in the arm at the site of the injection. Others experience fatigue, headache, muscle aches, stomach pain or nausea that might last for two to three days.

The CDC says vaccination is more than 90% effective at preventing shingles and postherpetic neuralgia in adults 50 years and older with healthy immune systems. The federal agency recommends that people 50 and older get two doses of the recombinant zoster vaccine, spaced two to six months apart.

That includes people who have had shingles or an older vaccine, Zostavax, which was discontinued in 2020. Younger adults also should get the vaccine if they are immunocompromised.

Vaccination might reduce the risk of cardiovascular complications from shingles as well. A 2021 study in the journal Stroke found that people who received the older vaccine had a lower risk of stroke than unvaccinated people.