Shingles: Live Zoster vaccination = 23% risk reduction in MACE

#1

https://doi.org/10.1093/eurheartj/ehaf230

There’s been a lot of talk on the forum about vaccines, latent infections, links between viruses and longevity recently. So this paper, published 4 days ago, is perfectly timed.

The highlights (curated and edited by me, not direct quotes):

Observational study

1,271,922 individuals, mean age 61.3, 43.2% male, median follow-up time, 6.0 years

Live zoster vaccination was associated with lower risks of overall cardiovascular events [HR 0.77, 95% confidence interval (CI) 0.76–0.78],

Major adverse cardiovascular events (MACE) [0.74 (0.71–0.77)], heart failure [0.74 (0.70–0.77)], cerebrovascular disorders [0.76 (0.74–0.78)], ischaemic heart disease [0.78 (0.76–0.80)], thrombotic disorders [0.78 (0.74–0.83)], and dysrhythmia [0.79 (0.77–0.81)].

Note, those are HUGE decreases in cardiovascular events. A 25% reduction is absolutely massive.

The protective association persisted up to 8 years, with the greatest reduction observed 2–3 years post-vaccination. The decrease in cardiovascular disease risk was more pronounced among males, individuals aged <60 years, those with unhealthy lifestyle habits, and those from low-income households and rural residents.

TO give some context, I used GPT with advanced reasoning to dig out comparative numbers of risk reductions for MACE:

Live Zoster vaccine (this paper) = 23% risk reduction

Never smoking vs smoking = 31% risk reduction

Lowering LDL-C from 160 to < 100 mg/dl = 32% risk reduction

Lowering systolic BP by 20mmHg = 34% risk reduction

Of course this is an observational study, so the real world application of the vaccine for MACE reduction may have different effectiveness. But a one-off vaccine giving at least 8 years of protection is pretty phenomenal IMO. It looks to me that the “bang for buck” of this vaccination seems extremely high. It’s especially cool that largest benefits seemed to be in the younger than 60, but the rest (unhealthy lifestyle, low income) probably doesn’t apply to this forum.

I can also say from personal experience that my wife had a shingles re-emergence in her early 40’s and it was absolutely horrible. She said it was excruciating pain. I believe @adssx has also recently mentioned that he had shingles. So perhaps avoiding that, and having some additional CVD benefits, is worthwhile?

Is anybody going to ask their doctor about this?

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Vaccines for longevity
Cardiovascular Health
#2

Yes. I’m definitely going to get this vaccine. Maybe convince my parents and wife to get it as well!

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#3

Thanks for sharing this. I tried to get that vaccine in the UK but couldn’t find a pharmacy giving it below 40yo. I should have tried harder (asking a doc to prescribe it?). I decided to postpone it until I’m 40yo and got it a few weeks later at age 32 :grimacing: So: don’t wait! The rates are increasing among young people and are now as high as they used to be for older people decades ago: Vaccines for longevity - #176 by adssx

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#4

I wonder if you may have a better shot of getting this <40 if you seem immunocompromised (e.g. being on steroid medications, etc. )

In any case the earlier shingles vaccine zostovax was the same as varicella vaccine but double dose (like wegovy vs ozempic :p)

So just get that, and then the eventual shingrix antibodies/t- cell immunity might be even more robust/ effective due to the mix-and-match approach…?

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#5

Can anyone speculate as to the mechanism here?

#6

Interesting. I’m in Australia where we can get Shingrix and Zostavax - free over 60 - to prevent shingles (herpes zoster) and its complications. Shingrix, is the most common option, and I got it at the beginning of the year.

However, it is a non-live vaccine, while Zostavax is a live-attenuated vaccine given as a single dose. I’m unsure if there’s any extended benefit from the non-live vaccine? In any event, the key power is in avoiding shingles which is horribly debilitating while it lasts.

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#7

Shingrix is very effective not sure why you wouldn’t get the same benefit with less risk of attenuated vaccine.

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#8

On my staff is a healthy jock type worker… got Shingles at age 32. Was miserable for several months… pain non stop… clothes were torture.

Got my 2 shingrix shots after witnessing that unfortunate situation. Healthy young people can get it… from chicken pox re-infection.

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#9
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#10

In the US it looks like Shingrix FDA approved for those 50+ or those for adults aged ≥19 years who are or will be immunodeficient or immunosuppressed. I am in my 40s and my doctor wont prescribe it for me. Sad because I think the risk/reward of this vaccine is highly favorable for many people like me that are bing prevented from accessing it.

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#11

OP like myself is less than 50. It is not easy for many of us to obtain a prescription for vaccines like this without leaving the US.

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#12

People interested in taking care of their health are more likely to get vaccinated?

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#13

Oh man, if only the team of professional public health scientists and the peer reviewers at EHJ (the highest rank research journal in cardiovascular medicine) had thought of this!

(Obviously, they controlled for this through multiple statistical methods…)

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#14

You don’t need a doctor’s prescription for Shingrix, it is given at a pharmacy without one (i just had the second one of two in the pharmacy of a Calif grocery store with no prescription.) You may face an issue with payment - as your health insurance won’t approve it for your age, but if you tell the pharmacist you’ll pay cash that shouldn’t be a problem.

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#15

Are you under 50? If so exactly which grocery store (I would rather go there than another country)? I have yet to find such a pharmacy that will allow anyone under 50 (without a rx from a doctor) to get Shingrix. I also haven’t found a doctor willing to prescribe it (since I am not immunocompromised, etc).

Insurance coverage is not my issue (I am fine paying cash).

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#16

Well stay simple. Shingrix decreases heart disease because it decreases shingles.

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#17

I think I also understood what KarlT just said: there’s not an unusual property of the vaccine that works some mysterious wonder; it’s that getting Shingles is bad for your brain. The vaccine won’t do a damn thing for your brain until the day you Didn’t get shingles --and you’ll never know it.

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#18

Of course what’s really needed here is a prospective double blind placebo controlled study.

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#19

I would guess this is the most likely, yeah. And I also assume they would have measured it in the study. Do you (or anybody else) have access to the full text?

Yeah I’m not expecting anything magical, but there are some weird cases out there where latent viruses (like this one - I assume we all had chicken pox as kids) seem to have other effect aside from the overt disease reoccurrence.

This study suggests a 20-30% increase in CVD risks in 12 years after shingles: Shingles associated with increased risks for cardiovascular disease | NHLBI, NIH So it would definitely seem plausible that vaccination reduces chances of shingles, thus lowers this risk.

In that case, it’s pretty much a no brainer to get the vaccine? You avoid a very unpleasant disease, and protect your heart and brain. Win-win?

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#20

Oh, by all means get the vax; I had shingles and it sucks so bad. But it must have been been known if there were any benefit in those vaxxed who didn’t get shingles. Is that stated in the research paper’s “Discussion”?

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