Shingles & Stroke – May be time to get that vaccine?

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New research has shown that shingles is a risk factor for TIA and stroke.

This increased risk is independent of other stroke risk factors such as hypternsions, smoking and high cholesterol.

People under 40 years of age who had had shingles were 74% more likely to have a stroke than those who had not.

Shingles is caused by the varicella-zoster virus (chicknepox).  The infection lies dormant in nerve roots, but when reactivated leads to a painful skin rash followed in some cases devastating post herpetic neuralgia

Current recommendations from the US Centers for Disease Control and Prevention (CDC) are that anyone aged 60 years and older receives the herpes zoster vaccine.

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The role for vaccination in younger individuals with vascular risk factors, and whether this can reduce stroke risk, has yet to be determined.

How could shingles cause stoke?  For cases where the rash involves the head and neck have led to virus spread into the cerebral arteries via the trigeminal nerve, leading to arthritis and stroke.  For other cases, the mechanism is unknown.

Click here to find out more about this study.

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Atrial Fibrillation? Better ask your doctor about anticoagulation.

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Atrial fibrillation (AF) is a major risk factor for TIA and Stroke.

It is estimated that AF accounts for >20% of all strokes.

This risk can be lowered by as much as 60% by taking an anticoagulant such as warfarin (Coumadin).

Current guidelines recommend anticoagulation for all patients with AF, even paroxysmal (intermittent) AF:

1. If they have had a prior TIA or stroke, or

2. If they have two or more of the following risk factors: (1) age > 75 years, (2) history of hypertension, (3) diabetes mellitus, and (4) moderately or severely impaired left ventricular systolic function and/or heart failure.

If you have AF, click here to calculate your CHADS2 score and stroke risk, and click here to calculate your risk of bleeding from anticoagulation.

Your risk of stroke is much higher than your bleeding risk, right?

Many AF patients don’t get anticoagulants because they are considered a fall risk. If you had AF and need anticoagulation, you would have to fall more than 300 times a year for the harm from the falls to outweigh the benefits of anticoagulation.

Despite these guidelines, recent studies have shown that:

1. Less than half of AF patients with a high stroke risk receive anticoagulants.

2. Even less patients with paroxysmal (intermittent) AF than those with permanent AF receive anticoagulants (31 vs 49%), even though the stroke risk is the same in both groups.

3. Too few patients with new onset AF are started on anticoagulants (only 52%).

We need to do better.


Click here to download a booklet about AF and stroke.

Click here to download a worksheet that you and your doctor can use to decide if anticoagulation is right for you.