Key result
Recombinant shingles vaccine linked to ~9% fewer cardiovascular events vs live vaccine over 7 years.
Why the study?
Does the recombinant shingles vaccine reduce the risk of cardiovascular events in adults aged ≥60 years compared to the live attenuated vaccine?
Observational
Does the recombinant shingles vaccine reduce the risk of cardiovascular events in adults aged ≥60 years compared to the live attenuated vaccine?
Effect estimate: RMTL ratio 0.91 (95% CI 0.88-0.95)
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“If confirmed in a [randomised controlled trial], the effect of Shingrix would be equivalent to antihypertensives.”
“Having already shown that this vaccine is linked to a lower risk of dementia, we now find it may also protect the heart. If confirmed in clinical trials, vaccinating older adults against shingles could prevent hundreds of thousands of coronary heart diseases, strokes and cases of heart failure worldwide, making it one of the most impactful interventions we could offer to protect both the brain and the heart in later life.”
“Beyond the established Shingles vaccine link to some protection from dementia and Alzheimer's disease, a large natural experiment provides evidence for a small (nearly 10%) reduction in stroke, heart failure, ischemic heart disease, and atrial fibrillation, broadening the association of benefit”
The recombinant shingles vaccine is associated with a 9% decrease in cardiovascular burden over 7 years compared to the live attenuated vaccine in adults aged ≥60 years, suggesting potential cardioprotective effects.
The recombinant herpes zoster (shingles) vaccine may reduce risks of cardiovascular disease. However, existing studies have compared vaccine recipients with non-recipients and, thus, are susceptible to confounding. To mitigate these biases, we conducted a natural experiment created by the rapid transition from the live attenuated to the recombinant shingles vaccine in the United States. We compared incidences of a composite cardiovascular endpoint (ischemic heart disease, heart failure or ischemic stroke) among adults aged ≥60 years vaccinated immediately before versus immediately after this transition. The recombinant vaccine was associated with a 9% decrease in cardiovascular burden over 7 years (restricted mean time lost (RMTL) ratio = 0.91, 95% confidence interval (CI): 0.88−0.95). The association attenuated over time and was significant for ischemic heart disease (10% decrease in burden; RMTL ratio = 0.90, 95% CI: 0.87−0.94) and heart failure (12% decrease in burden; RMTL ratio = 0.88, 95% CI: 0.83−0.93) in both sexes and ischemic stroke in males (12% decrease; RMTL ratio = 0.88, 95% CI: 0.78−0.98). An association was also seen for atrial fibrillation (7% decrease in burden; RMTL = 0.93, 95% CI: 0.88−0.98) but not other cardiac, peripheral and cerebrovascular outcomes. Results were consistent in secondary analyses. These results justify clinical trials and mechanistic studies to investigate potential cardioprotective effects of shingles vaccines.
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Corsi-Zuelli et al. (2026) reported an observational. Recombinant shingles vaccine vs. Live attenuated shingles vaccine was evaluated on Composite cardiovascular endpoint (ischemic heart disease, heart failure or ischemic stroke) (RMTL ratio 0.91, 95% CI 0.88-0.95). The recombinant shingles vaccine was associated with a 9% decrease in a composite cardiovascular endpoint over 7 years compared to the live attenuated vaccine (RMTL ratio 0.91; 95% CI 0.88-0.95).
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