A large-scale, nationwide study from South Korea suggests that vaccination with the live zoster vaccine is associated with a significantly lower risk of various cardiovascular (CV) events in adults aged 50 and older. The findings indicate a protective association that persists for up to 8 years post-vaccination.¹

This population-based cohort study analysed data from over 2.2 million individuals aged ≥50 years in South Korea, using national health insurance, examination, and vaccination records from 2012 to 2024. After propensity score–based overlap weighting to balance covariates, the final cohort included 1,271,922 individuals (635,961 vaccinated and 635,961 unvaccinated), with a mean age of 61.3 years and a median follow-up of 6.0 years.

The primary outcome was the risk of incident cardiovascular diseases. Secondary outcomes included major adverse cardiovascular events (MACEs), heart failure, cerebrovascular disorders, ischaemic heart disease, thrombotic disorders, and dysrhythmia.

Individuals who received the live zoster vaccine had a significantly lower risk of overall cardiovascular events compared with the unvaccinated group (HR 0.77; 95% CI 0.76–0.78).¹

Significant risk reductions were observed across several secondary outcomes:

• MACE: HR 0.74 (95% CI 0.71–0.77)
• Heart Failure: HR 0.74 (95% CI 0.70–0.77)
• Cerebrovascular disorders: HR 0.76 (95% CI 0.74–0.78)
• Ischaemic heart disease: HR 0.78 (95% CI 0.76–0.80)
• Thrombotic disorders: HR 0.78 (95% CI 0.74–0.83)
• Dysrhythmia: HR 0.79 (95% CI 0.77–0.81)

The protective association was most pronounced 2–3 years after vaccination and remained evident for up to 8 years. The reduction in CV risk was more prominent among males, individuals younger than 60 years, those with unhealthy lifestyle habits, and individuals from low-income households or rural areas.

Herpes zoster (HZ) infection has been previously linked to an increased risk of acute CV events, potentially through mechanisms like varicella-zoster virus (VZV) vasculopathy and inflammation.² This study suggests that by preventing HZ, the live zoster vaccine may also mitigate this associated cardiovascular risk. The authors concluded, "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."¹

The study's limitations include its focus on an Asian cohort and the unavailability of data on the newer recombinant zoster vaccine. Further research is needed to confirm these findings in other populations and to evaluate the cardiovascular effects of the recombinant vaccine.

This study was funded by the National Research Foundation of Korea (NRF) and the Ministry of Science and ICT (MSIT), Korea.

References

1. Lee S, Lee K, Oh J, et al. Live zoster vaccination and cardiovascular outcomes: a nationwide, South Korean study. Eur Heart J. 2025;46(30):2991-3002. https://doi.org/10.1093/eurheartj/ehaf230

2. Minassian C, Thomas SL, Smeeth L, et al. Acute cardiovascular events after herpes zoster: a self-controlled case series analysis in vaccinated and unvaccinated older residents of the United States. PLoS Med. 2015;12:e1001919. https://doi.org/10.1371/journal.pmed.1001919

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