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Eur. Heart J., 05 May 2025 | https://doi.org/10.1093/eurheartj/ehaf230
Live zoster vaccination and cardiovascular outcomes: a nationwide, South Korean study
Sooji Lee 1,2,†, Kyeongmin Lee 1,3,†, Jiyeon Oh 1,2, Hyeon Jin Kim 1,3, Yejun Son 1, Soeun Kim 1, Jaeyu Park 1,3, Jiseung Kang 4,5,6, Damiano Pizzol 7,8, Jinseok Lee 9, Ho Geol Woo 1,10, Hayeon Lee 1,9,11,*, and Dong Keon Yon 1,2,3,9,12,13,*
1Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, South Korea;
2Department of Medicine, Kyung Hee University College of Medicine, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, South Korea;
3Department of Regulatory Science, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, South Korea;
4Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA;
5Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA;
6School of Health and Environmental Science, College of Health Science, Korea University, Seoul, South Korea;
7Health Unit Eni, Maputo, Mozambique;
8Health Unit, Eni, San Donato Milanese, Italy;
9Department of Biomedical Engineering, Kyung Hee University, 1732, Deogyeong-daero, Giheung-gu, Yongin 17104, South Korea;
10Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea;
11Department of Electronics and Information Convergence Engineering, Kyung Hee University, 1732, Deogyeong-daero, Giheung-gu, Yongin 17104, South Korea;
12Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, South Korea; and
13Department of Precision Medicine, Kyung Hee University College of Medicine, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, South Korea
* Corresponding authors: Hayeon Lee and Dong Keon Yon
† The first two authors contributed equally to the study.
1Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, South Korea;
2Department of Medicine, Kyung Hee University College of Medicine, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, South Korea;
3Department of Regulatory Science, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, South Korea;
4Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA;
5Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA;
6School of Health and Environmental Science, College of Health Science, Korea University, Seoul, South Korea;
7Health Unit Eni, Maputo, Mozambique;
8Health Unit, Eni, San Donato Milanese, Italy;
9Department of Biomedical Engineering, Kyung Hee University, 1732, Deogyeong-daero, Giheung-gu, Yongin 17104, South Korea;
10Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea;
11Department of Electronics and Information Convergence Engineering, Kyung Hee University, 1732, Deogyeong-daero, Giheung-gu, Yongin 17104, South Korea;
12Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, South Korea; and
13Department of Precision Medicine, Kyung Hee University College of Medicine, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, South Korea
* Corresponding authors: Hayeon Lee and Dong Keon Yon
† The first two authors contributed equally to the study.
Abstract
Background and Aims
Despite the potential association between herpes zoster infection and cardiovascular events, limited studies have investigated the relationship between live zoster vaccination and cardiovascular outcomes. This large-scale, population-based cohort study with a long-term follow-up aimed to investigate the association between live zoster vaccination and the risk of various cardiovascular events.
Methods
Data on comprehensive information of individuals aged ≥50 years from South Korea (n = 2 207 784) were included from 1 January 2012, to 31 December 2021. National insurance information from the Korea Health Insurance Review and Assessment Service, the national health examination results from the Korean National Health Insurance Service, and the live zoster vaccination data from the Korea Disease Control and Prevention Agency were merged. The risk of incident cardiovascular outcomes after live zoster vaccination was assessed compared with unvaccinated individuals. The primary outcome was the risk of cardiovascular diseases based on International Classification of Diseases, Tenth Revision code diagnosis. In propensity score–based overlap weighted cohorts, Cox proportional hazard models were used to estimate hazard ratios (HRs) for overall and specific cardiovascular outcomes, while calculating restricted mean survival time (RMST) for each outcome. The observation period was from 1 January 2012, to 31 January 2024. Multiple stratification analyses were performed.
Results
After applying propensity score–based overlap weighting, 1 271 922 individuals were included [mean age, 61.3 years (standard deviation, 3.4); 548 986 (43.2%) male; median follow-up time, 6.0 years] in overlap-weighted cohort. Live zoster vaccination was associated with lower risks of overall cardiovascular events [HR 0.77, 95% confidence interval (CI) 0.76–0.78], particularly major adverse cardiovascular events [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)]. The RMST difference for overall cardiovascular events following live zoster vaccination was 95.14 days per decade (95% CI 94.99–95.30). 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.
Conclusions
These findings suggest that live zoster vaccination may be beneficial as a public health strategy with potential implications for cardiovascular disease burden in the general population. This strategy may help address health disparities and mortality linked to cardiovascular complications.
Despite the potential association between herpes zoster infection and cardiovascular events, limited studies have investigated the relationship between live zoster vaccination and cardiovascular outcomes. This large-scale, population-based cohort study with a long-term follow-up aimed to investigate the association between live zoster vaccination and the risk of various cardiovascular events.
Methods
Data on comprehensive information of individuals aged ≥50 years from South Korea (n = 2 207 784) were included from 1 January 2012, to 31 December 2021. National insurance information from the Korea Health Insurance Review and Assessment Service, the national health examination results from the Korean National Health Insurance Service, and the live zoster vaccination data from the Korea Disease Control and Prevention Agency were merged. The risk of incident cardiovascular outcomes after live zoster vaccination was assessed compared with unvaccinated individuals. The primary outcome was the risk of cardiovascular diseases based on International Classification of Diseases, Tenth Revision code diagnosis. In propensity score–based overlap weighted cohorts, Cox proportional hazard models were used to estimate hazard ratios (HRs) for overall and specific cardiovascular outcomes, while calculating restricted mean survival time (RMST) for each outcome. The observation period was from 1 January 2012, to 31 January 2024. Multiple stratification analyses were performed.
Results
After applying propensity score–based overlap weighting, 1 271 922 individuals were included [mean age, 61.3 years (standard deviation, 3.4); 548 986 (43.2%) male; median follow-up time, 6.0 years] in overlap-weighted cohort. Live zoster vaccination was associated with lower risks of overall cardiovascular events [HR 0.77, 95% confidence interval (CI) 0.76–0.78], particularly major adverse cardiovascular events [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)]. The RMST difference for overall cardiovascular events following live zoster vaccination was 95.14 days per decade (95% CI 94.99–95.30). 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.
Conclusions
These findings suggest that live zoster vaccination may be beneficial as a public health strategy with potential implications for cardiovascular disease burden in the general population. This strategy may help address health disparities and mortality linked to cardiovascular complications.
논문정보
- Research article
- 2025년 05월 (BRIC 등록일 2025-05-06)
- 국내(교신)+국외 연구진
- 바이오·의료융합 > 바이오·의료융합 기타
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