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The association of stroke with herpes zoster ophthalmicus

Eye volume 38, pages 488–493 (2024)Cite this article

Subjects

Abstract

Background/objectives

Studies have reported an association between herpes zoster ophthalmicus (HZO) and stroke. We sought to validate this association with rigorous controls for both medical comorbidities and social factors using a nationwide U.S. administrative medical claims database.

Subjects/methods

A two-step approach was taken: first a retrospective case-control study was performed, followed by a self-controlled case series (SCCS). For the case control study, cox proportional hazard regression with inverse proportional treatment weighting assessed the hazard for stroke. In the SCCS, incidence of stroke was compared prior to and after the diagnosis of HZO.

Results

For the case–control study, 25,720 cases and 75,924 controls met our eligibility criteria. 1712 (6.7%) and 4544 (6.0%) strokes occurred in the case and control groups respectively, conferring an 18% increased risk of stroke in the observed 1-year post-HZO period (HR = 1.18, 95% CI: 1.12–1.25, p < 0.001). SCCS analysis showed the risk for stroke was highest in the month immediately after HZO episode compared to any other time range (1–30 days after, relative risk 1.58, p < 0.001) and even higher when assessing time more distal time points prior to the HZO diagnosis (days 1–30 after HZO diagnosis had RR = 1.69 (95% CI: 1.38–2.07) and RR = 1.93 (95% CI: 1.55–2.39) compared with days −120 to −91 and −150 to −121 prior to index, respectively (p < 0.001).

Conclusions

After accounting for stroke risk factors, our analysis confirms the association between HZO and stroke, with highest risk in the immediate month after an episode.

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Fig. 1: Flowchart of patients included in cohort study.
Fig. 2: HZO patients have a high cummulative probability of stroke compared to matched controls.

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Data availability

The source data for this study were licensed by Optum, and hence we are not allowed to share the licensed data publicly.

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Acknowledgements

Meeting presentation: Results to be presented at the ARVO annual meeting, New Orleans, LA, April 25th, 2023.

Funding

National Institutes of Health University of Pennsylvania Core Grant for Vision Research (2P30EYEY001583). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Additional funding was provided by Research to Prevent Blindness and the Paul and Evanina Mackall Foundation. Funding from each of the above sources was received in the form of block research grants to the Scheie Eye Institute. None of the funding organizations had any role in the design or conduction of the study.

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Authors and Affiliations

  1. Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Philadelphia, Philadelphia, PA, USA

    Angela S. Gupta, Tejus Pradeep, Stephen E. Orlin & Brian L. VanderBeek

  2. Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Yinxi Yu

  3. Department of Biostatistics & Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Brian L. VanderBeek

  4. Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Brian L. VanderBeek

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Contributions

ASG, BVB, and SEO designed the study. YY responsible for data analysis and statistics. ASG, TP, and BVB wrote up the report. YY and SEO provided edits to the written report.

Corresponding author

Correspondence to Brian L. VanderBeek.

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Competing interests

ASG, TP, YY have no financial disclosures. BVB has no relevant financial disclosures and has consulted for EyePoint Pharmaceuticals. SEO is a consultant for Abbvie.

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Gupta, A.S., Pradeep, T., Yu, Y. et al. The association of stroke with herpes zoster ophthalmicus. Eye 38, 488–493 (2024). https://doi.org/10.1038/s41433-023-02708-4

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