Shingles, a reactivation of the varicella-zoster virus, is emerging as a significant, often overlooked, risk factor for stroke, particularly ischemic stroke, in individuals aged 50 and above. Research indicates that contracting shingles can lead to a notably higher likelihood of stroke, especially within the initial weeks following the infection, due to inflammation and damage to blood vessels. This association is attributed to viral reactivation, which triggers inflammatory responses and can affect sympathetic activity and immune responses, all of which can compromise vascular health. The risk is further amplified if shingles occur near the eye and antiviral treatment is not administered, underscoring the importance of prompt medical attention. Given the substantial stroke burden among the elderly, especially in countries like India, recognizing shingles as a potential contributor highlights the necessity of integrating awareness of such infections into broader preventive health strategies that go beyond traditional cardiovascular risk factors.

Shingles, a reactivation of the varicella-zoster virus, is emerging as a significant, often overlooked, risk factor for stroke, particularly ischemic stroke, in individuals aged 50 and above. Research indicates that contracting shingles can lead to a notably higher likelihood of stroke, especially within the initial weeks following the infection, due to inflammation and damage to blood vessels. This association is attributed to viral reactivation, which triggers inflammatory responses and can affect sympathetic activity and immune responses, all of which can compromise vascular health. The risk is further amplified if shingles occur near the eye and antiviral treatment is not administered, underscoring the importance of prompt medical attention. Given the substantial stroke burden among the elderly, especially in countries like India, recognizing shingles as a potential contributor highlights the necessity of integrating awareness of such infections into broader preventive health strategies that go beyond traditional cardiovascular risk factors.

Shingles, a reactivation of the varicella-zoster virus, is emerging as a significant, often overlooked, risk factor for stroke, particularly ischemic stroke, in individuals aged 50 and above. Research indicates that contracting shingles can lead to a notably higher likelihood of stroke, especially within the initial weeks following the infection, due to inflammation and damage to blood vessels. This association is attributed to viral reactivation, which triggers inflammatory responses and can affect sympathetic activity and immune responses, all of which can compromise vascular health. The risk is further amplified if shingles occur near the eye and antiviral treatment is not administered, underscoring the importance of prompt medical attention. Given the substantial stroke burden among the elderly, especially in countries like India, recognizing shingles as a potential contributor highlights the necessity of integrating awareness of such infections into broader preventive health strategies that go beyond traditional cardiovascular risk factors.

Stroke remains one of the leading causes of disability and death among older adults aged 50 years and above. While established risk factors such as hypertension, diabetes and high cholesterol are well recognised, growing evidence suggests that certain infections may also contribute to vascular risk. One such infection is shingles, an often-overlooked condition that may have implications beyond the skin.

Shingles, also known as herpes zoster (HZ), is a painful, blistering rash caused by the reactivation of the varicella-zoster virus. While shingles and cardiovascular diseases such as ischemic stroke are distinct conditions, recent research indicates that individuals who develop shingles have a significantly higher risk of stroke than those who have not experienced the infection.

Why does shingles increase the risk of stroke?

Although the exact mechanisms underlying this association are still being investigated, researchers believe that shingles may contribute to vascular complications through several pathways. These include viral reactivation and replication, which trigger inflammation and damage to blood vessels, as well as viral spread along nerves. In addition, increased sympathetic activity can lead to elevated blood pressure, while changes in immune responses may further contribute to these effects. Together, these findings underscore the need for greater awareness of the link between shingles and ischemic stroke, particularly among older adults aged 50 years and above, who are already at a higher risk of both conditions.

Multiple epidemiological studies have shown that shingles infection is associated with an increased short-term risk of ischemic stroke, particularly within the first month following infection, driven by inflammation and thrombosis triggered by the varicella-zoster virus (VZV), the virus that causes shingles.

The risk of ischemic stroke is highest in the initial 5–12 weeks after shingles near the eye if the patient did not receive antiviral treatment. Since shingles infection damages blood vessels in the brain, the chances of stroke become higher.

India already faces a substantial stroke burden among the elderly population. The annual stroke incidence among Indians aged 70 years and above was approximately 719 per 100,000 population in 2021, nearly three times higher than among those aged 50–69 years (241 per 100,000). Recognising shingles as a potential contributor to vascular complications highlights the importance of a broader preventive health strategy, particularly for older adults and individuals living with chronic conditions.

Managing stroke through lifestyle and medical modifications

Protecting long-term health requires looking beyond traditional cardiovascular risk factors alone. Alongside maintaining healthy blood pressure, cholesterol levels, physical activity, and diabetes management, preventive healthcare should also include awareness of infections that may affect overall vascular well-being.

Saying no to tobacco products, managing chronic conditions such as diabetes and high blood pressure, maintaining a healthy weight, and choosing a diet low in saturated fats and salt are equally essential to lead a disease-free life. If you're over 50 years old and are at risk of shingles, consult your healthcare professional today. They can help you understand your risk of shingles and stroke.

The author is a consultant interventional cardiologist at NH- Rabindranath Tagore International Institute of Cardiac Sciences. 

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK. 

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