Risk of Stroke after Herpes Zoster - Evidence from a German Self-Controlled Case-Series Study
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Risk of Stroke after Herpes Zoster - Evidence from a German Self-Controlled Case-Series Study. / Schink, Tania; Behr, Sigrid; Thöne, Kathrin; Bricout, Hélène; Garbe, Edeltraut.
In: PLOS ONE, Vol. 11, No. 11, 2016, p. e0166554.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Risk of Stroke after Herpes Zoster - Evidence from a German Self-Controlled Case-Series Study
AU - Schink, Tania
AU - Behr, Sigrid
AU - Thöne, Kathrin
AU - Bricout, Hélène
AU - Garbe, Edeltraut
PY - 2016
Y1 - 2016
N2 - BACKGROUND: Herpes zoster (HZ) is caused by reactivation of the latent varicella-zoster virus (VZV). A severe complication of HZ is VZV vasculopathy which can result in ischemic or hemorrhagic stroke. The aims of our study were to assess the risk of stroke after the onset of HZ and to investigate the roles of stroke subtype, HZ location and the time interval between HZ onset and stroke.METHODS: A self-controlled case-series study was performed on a cohort of patients with incident stroke recorded in the German Pharmacoepidemiological Research Database (GePaRD), which covers about 20 million persons throughout Germany. We estimated adjusted incidence rate ratios (IRR) by comparing the rate of stroke in risk periods (i.e., periods following HZ) with the rate of stroke in control periods (i.e., periods without HZ) in the same individuals, controlling for both time-invariant and major potentially time-variant confounders.RESULTS: The cohort included 124,462 stroke patients, of whom 6,035 (5%) had at least one HZ diagnosis identified in GePaRD either as main hospital discharge diagnosis or as HZ treated with antivirals. The risk of stroke was about 1.3 times higher in the risk periods 3 months after HZ onset, than in the control periods (IRR: 1.29; 95% confidence interval: 1.16-1.44). An elevated risk of similar magnitude was observed for ischemic and unspecified stroke, but a 1.5-fold higher risk was observed for hemorrhagic stroke. A slightly stronger effect on the risk of stroke was also observed during the 3 months after HZ ophthalmicus (HZO) onset (1.59; 1.10-2.32). The risk was highest 3 and 4 weeks after HZ onset and decreased thereafter.CONCLUSIONS: Our study corroborates an increased risk of stroke after HZ, which is highest 3 to 4 weeks after HZ onset. The results suggest that the risk is more pronounced after HZO and is numerically higher for hemorrhagic than for ischemic stroke.
AB - BACKGROUND: Herpes zoster (HZ) is caused by reactivation of the latent varicella-zoster virus (VZV). A severe complication of HZ is VZV vasculopathy which can result in ischemic or hemorrhagic stroke. The aims of our study were to assess the risk of stroke after the onset of HZ and to investigate the roles of stroke subtype, HZ location and the time interval between HZ onset and stroke.METHODS: A self-controlled case-series study was performed on a cohort of patients with incident stroke recorded in the German Pharmacoepidemiological Research Database (GePaRD), which covers about 20 million persons throughout Germany. We estimated adjusted incidence rate ratios (IRR) by comparing the rate of stroke in risk periods (i.e., periods following HZ) with the rate of stroke in control periods (i.e., periods without HZ) in the same individuals, controlling for both time-invariant and major potentially time-variant confounders.RESULTS: The cohort included 124,462 stroke patients, of whom 6,035 (5%) had at least one HZ diagnosis identified in GePaRD either as main hospital discharge diagnosis or as HZ treated with antivirals. The risk of stroke was about 1.3 times higher in the risk periods 3 months after HZ onset, than in the control periods (IRR: 1.29; 95% confidence interval: 1.16-1.44). An elevated risk of similar magnitude was observed for ischemic and unspecified stroke, but a 1.5-fold higher risk was observed for hemorrhagic stroke. A slightly stronger effect on the risk of stroke was also observed during the 3 months after HZ ophthalmicus (HZO) onset (1.59; 1.10-2.32). The risk was highest 3 and 4 weeks after HZ onset and decreased thereafter.CONCLUSIONS: Our study corroborates an increased risk of stroke after HZ, which is highest 3 to 4 weeks after HZ onset. The results suggest that the risk is more pronounced after HZO and is numerically higher for hemorrhagic than for ischemic stroke.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Antiviral Agents
KW - Case-Control Studies
KW - Databases, Factual
KW - Female
KW - Germany
KW - Herpes Zoster
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Risk Factors
KW - Self Care
KW - Stroke
KW - Journal Article
U2 - 10.1371/journal.pone.0166554
DO - 10.1371/journal.pone.0166554
M3 - SCORING: Journal article
C2 - 27880853
VL - 11
SP - e0166554
JO - PLOS ONE
JF - PLOS ONE
SN - 1932-6203
IS - 11
ER -