Herpes Zoster Vaccination as Cardiovascular Prevention in Adults with Heart Disease

To summarize the evidence linking herpes zoster (HZ) with cardiovascular events and assess whether HZ vaccination may reduce cardiovascular risk, with particular attention to the transition from live attenuated vaccine (ZVL) to adjuvanted recombinant vaccine (RZV).

Narrative review structured around SANRA quality domains, based on searches of PubMed/MEDLINE, Embase, Cochrane CENTRAL, ClinicalTrials.gov, and guideline and grey-literature sources through 12 August 2026, with two peer-review-identified sources added thereafter.

HZ is associated with a transient increase in stroke and myocardial infarction risk, particularly after ophthalmic HZ. The strongest population-level cardiovascular evidence concerns ZVL, with a South Korean cohort showing reductions in major cardiovascular events, heart failure, and stroke sustained for up to 8 years; ZVL is now withdrawn in the United States and European Union. A natural-experiment study directly comparing the platforms found a further 9% reduction in cardiovascular burden with RZV versus ZVL over 7 years. Real-world cohorts in high-risk populations and a peer-reviewed meta-analysis also support cardiovascular benefit, although most pooled analyses combine RZV and ZVL, and no randomized trial has been designed specifically for cardiovascular outcomes.

Evidence increasingly supports a cardiovascular benefit of HZ vaccination, including with RZV currently in use, but remains predominantly observational or quasi-experimental. Dedicated randomized cardiovascular-outcome trials are needed.