Protective Effects of Recombinant Zoster Vaccine and Antiviral Therapy Against Cardiovascular Disease Following Herpes Zoster Infection

Background Herpes zoster (HZ) is associated with a higher risk of cardiovascular events, but the effect of the recombinant zoster vaccine (RZV) on this risk, alone or in combination with antiviral treatment, remains uncertain. The aim of this study was to evaluate the impact of RZV on the risk of cardiovascular disease (CVD) events following HZ infection.Methods We conducted a retrospective cohort study using the Optum Labs Data Warehouse. Adults aged >= 50 years with HZ diagnosed between 1 January 2018 and 31 March 2023 were included. Participants were categorized by their receipt of RZV and antiviral treatment for HZ. A Cox multivariable proportional hazards model estimated the association with post-HZ cardiovascular events.Results Among 112 637 patients with HZ, 5240 (4.7%) received both RZV and antiviral therapy, 2644 (2.3%) received RZV alone, 80 871 (71.8%) received antiviral therapy alone, and 23 882 (21.2%) received neither. RZV alone reduced the CVD risk by 21% (95% confidence interval, 6%-33%), antiviral therapy alone by 22% (16%-26%), and receipt of both by 39% (28%-47%).Conclusions This study underscores the effectiveness of RZV and antiviral therapy in mitigating cardiovascular risks after HZ infection. Having both preventive vaccination and therapeutic antiviral intervention may offer enhanced protection against CVD and death. In this insurance claims-based retrospective cohort study, receipt of the recombinant zoster vaccine, timely antiviral treatment, or both was associated with a significantly decreased risk of cardiovascular disease in the year following a herpes zoster infection.