Herpes zoster infection and statins: which implications in clinical practice?

  • Marco Zuin
  • Gianluca Rigatelli
  • Roberto L’Erario
  • Giovanni Zuliani
  • Claudio Bilato
  • Loris RonconEmail author
Original Article


Herpes zoster (HZ), which is caused by reactivation of latent varicella zoster virus (VZV), constitutes a major public health concern in both short- and long-term periods. Over the last years, several epidemiological studies have demonstrated that statin use is associated with increased risk of HZ at cerebral level. Because statins are among the most popular and best-selling drugs in western countries, this potential negative pleiotropic effect could have important implications in the daily clinical practice. In the present manuscript, we reviewed the available data on the statin use and the relative risk of HZ infection.


Herpes zoster Statin Immunomodulatory effect 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Not required for a review article.

Informed consent

Not required for a review article.


  1. 1.
    Stein AN, Britt H, Harrison C, Conway EL, Cunningham A, Macintyre CR (2009) Herpes zoster burden of illness and health care resource utilisation in the Australian population aged 50 years and older. Vaccine 27:520–529CrossRefGoogle Scholar
  2. 2.
    Yawn BP, Gilden D (2013) The global epidemiology of herpes zoster. Neurology 81:928–930CrossRefGoogle Scholar
  3. 3.
    Leung J, Harpaz R, Molinari NA, Jumaan A, Zhou F (2011) Herpes zoster incidence among insured persons in the United States, 1993-2006: evaluation of impact of varicella vaccination. Clin Infect Dis 52:332–340CrossRefGoogle Scholar
  4. 4.
    Johnson RW, Alvarez-Pasquin MJ, Bijl M, Franco E, Gaillat J, Clara JG, Labetoulle M, Michel JP, Naldi L, Sanmarti LS, Weinke T (2015) Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective. Ther Adv Vaccines 3:109–120CrossRefGoogle Scholar
  5. 5.
    Matthews A, Turkson M, Forbes H, Langan SM, Smeeth L, Bhaskaran K (2016) Statin use and the risk of herpes zoster: a nested case-control study using primary care data from the U.K. Clinical Research Practice Datalink. Br J Dermatol 175:1183–1194CrossRefGoogle Scholar
  6. 6.
    Chen HH, Lin CL, Yeh CJ, Yeh SY, Kao CH (2015) Statins can increase the risk of herpes zoster infection in Asia. Eur J Clin Microbiol Infect Dis 34:1451–1458CrossRefGoogle Scholar
  7. 7.
    Kim MC, Yun SC, Lee SO, Choi SH, Kim YS, Woo JH, Kim SH (2018) Statins increase the risk of herpes zoster: a propensity score-matched analysis. PLoS One 13:e0198263CrossRefGoogle Scholar
  8. 8.
    Chung SD, Tsai MC, Liu SP, Lin HC, Kang JH (2014) Herpes zoster is associated with prior statin use: a population-based case-control study. PLoS One 9:e111268CrossRefGoogle Scholar
  9. 9.
    Antoniou T, Zheng H, Singh S, Juurlink DN, Mamdani MM, Gomes T (2014) Statins and the risk of herpes zoster: a population-based cohort study. Clin Infect Dis 58:350–356CrossRefGoogle Scholar
  10. 10.
    O’Keeffe AG, Nazareth I, Petersen I (2016) Time trends in the prescription of statins for the primary prevention of cardiovascular disease in the United Kingdom: a cohort study using The Health Improvement Network primary care data. Clin Epidemiol 8:123–132CrossRefGoogle Scholar
  11. 11.
    Chou R, Dana T, Blazina I, Daeges M, Jeanne TL (2016) Statins for prevention of cardiovascular disease in adults: evidence report and systematic review for the US Preventive Services Task Force. JAMA 316:2008–2024CrossRefGoogle Scholar
  12. 12.
    Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, Hoes AW, Jennings CS, Landmesser U, Pedersen TR, Reiner Ž, Riccardi G, Taskinen MR, Tokgozoglu L, Verschuren WMM, Vlachopoulos C, Wood DA, Zamorano JL, Cooney MT, ESC Scientific Document Group (2016) 2016 ESC/EAS guidelines for the management of dyslipidaemias. Eur Heart J 37:2999–3058CrossRefGoogle Scholar
  13. 13.
    Mohammad S, Nguyen H, Nguyen M, Abdel-Rasoul M, Nguyen V, Nguyen CD, Nguyen KT, Li L, Kitzmiller JP (2018) Pleotropic Effects of Statins: untapped potential for statin pharmacotherapy. Curr Vasc Pharmacol.
  14. 14.
    Forbes HJ, Bhaskaran K, Thomas SL, Smeeth L, Clayton T, Langan SM (2014) Quantification of risk factors for herpes zoster: population based case-control study. BMJ 348:g2911CrossRefGoogle Scholar
  15. 15.
    Liao JK, Laufs U (2005) Pleiotropic effects of statins. Annu Rev Pharmacol Toxicol 45:89–118CrossRefGoogle Scholar
  16. 16.
    van den Hoek HL, Bos WJ, de Boer A, van de Garde EM (2011) Statins and prevention of infections: systematic review and meta-analysis of data from large randomised placebo controlled trials. BMJ 343:d7281CrossRefGoogle Scholar
  17. 17.
    Tleyjeh IM, Kashour T, Hakim FA, Zimmerman VA, Erwin PJ, Sutton AJ, Ibrahim T (2009) Statins for the prevention and treatment of infections: a systematic review and meta-analysis. Arch Intern Med 169:1658–1667CrossRefGoogle Scholar
  18. 18.
    Vandermeer ML, Thomas AR, Kamimoto L, Reingold A, Gershman K, Meek J, Farley MM, Ryan P, Lynfield R, Baumbach J, Schaffner W, Bennett N, Zansky S (2012) Association between use of statins and mortality among patients hospitalized with laboratory-confirmed influenza virus infections: a multistate study. J Infect Dis 205:13–19CrossRefGoogle Scholar
  19. 19.
    Gilbert C, Bergeron M, Méthot S, Giguère JF, Tremblay MJ (2005) Statins could be used to control replication of some viruses, including HIV-1. Viral Immunol 18:474–489CrossRefGoogle Scholar
  20. 20.
    Minassian C, Thomas SL, Smeeth L, Douglas I, Brauer R, Langan SM (2015) Acute cardiovascular events after herpes zoster: a self-controlled case series analysis in vaccinated and unvaccinated older residents of the United States. PLoS Med 12:e1001919CrossRefGoogle Scholar
  21. 21.
    Erskine N, Tran H, Levin L, Ulbricht C, Fingeroth J, Kiefe C, Goldberg RJ, Singh S (2017) A systematic review and meta-analysis on herpes zoster and the risk of cardiac and cerebrovascular events. PLoS One 12:e0181565CrossRefGoogle Scholar
  22. 22.
    Laing SP, Swerdlow AJ, Slater SD, Burden AC, Morris A, Waugh NR, Gatling W, Bingley PJ, Patterson CC (2003) Mortality from heart disease in a cohort of 23,000 patients with insulin-treated diabetes. Diabetologia 46:760–765CrossRefGoogle Scholar
  23. 23.
    Mooradian AD (2009) Dyslipidemia in type 2 diabetes mellitus. Nat Clin Pract Endocrinol Metab 5:150–159Google Scholar
  24. 24.
    Hajar R (2017) Diabetes as “coronary artery disease risk equivalent”: a historical perspective. Heart Views 18:34–37CrossRefGoogle Scholar
  25. 25.
    Nayor M, Vasan RS (2016) Recent update to the US cholesterol treatment guidelines: a comparison with international guidelines. Circulation 133:1795–1806CrossRefGoogle Scholar
  26. 26.
    Greenwood J, Steinman L, Zamvil SS (2006) Statin therapy and autoimmune disease: from protein prenylation to immunomodulation. Nat Rev Immunol 6:358–370CrossRefGoogle Scholar
  27. 27.
    Ghittoni R, Lazzerini PE, Pasini FL, Baldari CT (2007) T lymphocytes as targets of statins: molecular mechanisms and therapeutic perspectives. Inflamm Allergy Drug Targets 6:3–16CrossRefGoogle Scholar
  28. 28.
    Mausner-Fainberg K, Luboshits G, Mor A, Maysel-Auslender S, Rubinstein A, Keren G, George J (2008) The effect of HMG-CoA reductase inhibitors on naturally occurring CD4+CD25+ T cells. Atherosclerosis 197(2):829–839CrossRefGoogle Scholar
  29. 29.
    Jenkins DE, Redman RL, Lam EM, Liu C, Lin I, Arvin AM (1998) Interleukin (IL)-10, IL-12, and interferon-gamma production in primary and memory immune responses to varicella-zoster virus. J Infect Dis 178:940–948CrossRefGoogle Scholar
  30. 30.
    Fedson DS (2003) Pandemic influenza and the global vaccine supply. Clin Infect Dis 36:1552–1561CrossRefGoogle Scholar
  31. 31.
    Paragh G, Seres I, Harangi M, Fülöp P (2014) Dynamic interplay between metabolic syndrome and immunity. Adv Exp Med Biol 824:171–190CrossRefGoogle Scholar
  32. 32.
    Collins R, Reith C, Emberson J, Armitage J, Baigent C, Blackwell L, Blumenthal R, Danesh J, Smith GD, DeMets D, Evans S, Law M, MacMahon S, Martin S, Neal B, Poulter N, Preiss D, Ridker P, Roberts I, Rodgers A, Sandercock P, Schulz K, Sever P, Simes J, Smeeth L, Wald N, Yusuf S, Peto R (2016) Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet 388:2532–2561CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Section of Internal and Cardiopulmonary MedicineUniversity of FerraraFerraraItaly
  2. 2.Department of CardiologySanta Maria della Misericordia HospitalRovigoItaly
  3. 3.Department of Cardiovascular Diagnosis and Endoluminal InterventionsSanta Maria della Misericordia HospitalRovigoItaly
  4. 4.Department of NeurosciencesSanta Maria della Misericordia HospitalRovigoItaly
  5. 5.Department of CardiologyOspedali dell’Ovest VicentinoArzignanoItaly

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