A recently published observational study compared cardiovascular outcomes of shingles vaccine recipients during the live-attenuated shingles vaccine (Zostavax) and the recombinant herpes zoster vaccine (Shingrix) eras. The group that received the recombinant vaccine had a lower risk of cardiovascular events over the next 7 years compared with the group that predominantly received the live vaccine.

I have previously written about the benefits of the shingles vaccine, including lower risk of dementia and heart disease. This new study adds to the evidence that getting the shingles vaccine not only reduces your risk of painful, debilitating shingles, but also protects seniors’ health.

This post reviews the new study and discusses how the recombinant shingles vaccine improves cardiovascular outcomes.

All about shingles and the shingles vaccine

Shingles is a complication of chickenpox, caused by the Varicella zoster virus (VZV). The body’s immune system does not eliminate VZV after chickenpox. Once chickenpox symptoms disappear, the virus stays in the dorsal root ganglion, a bundle of nerve fibers at the bottom of the spinal column. The virus remains there, hidden from the body’s immune system.

Even though the body developed an immune response to the original zoster virus infection, several years or decades after the initial infection, the adaptive immune response against the virus wanes or disappears. Due to other unknown factors, possibly stress or other infections like COVID-19 or VZV, the virus “moves” along nerve bundles and initiates a secondary infection with much more serious consequences for the individual.

This second VZV infection, called herpes zoster, is more commonly known as shingles. Shingles usually occurs in adults older than 50, although it can occur at any age, even in young adults. 

Although the same virus causes chickenpox and shingles, shingles was given a different name, herpes zoster, probably because it was originally thought to be caused by a similar but unrelated virus.

Shingles is an entirely unpredictable disease. It reactivates due to unknown causes. Once shingles appears, it can be painful, depending on the location. It can cause blindness (from herpes zoster ophthalmicus), disfigurement of the infected area, permanent pain (postherpetic neuralgia), and other conditions.

Shingles can be treated with antiviral drugs, but only if the infection is recognized and treated within 24-72 hours, which means the stricken individual must seek treatment quickly.

Post-herpetic neuralgia pain may last for weeks, months, or even years after the blisters have healed – this is not a trivial disease.

Shingles is not a one-time event. After you develop shingles, it may return in months or years, so it is important to be vaccinated even if you have had shingles.

Almost all individuals in the US aged 50 years and older have been infected with VZV (from chickenpox) and are therefore at risk for shingles. There’s a growing body of evidence that herpes viruses, including VZV, may be linked to cognitive decline.

The only way to prevent a shingles infection is to boost the immune system with a vaccine against the zoster virus. The CDC recommends Shingrix (also known as the zoster vaccine, available in the USA), a relatively new, safe, and effective vaccine that prevents shingles. Shingrix has replaced the older shingles vaccine, Zostavax, because Shingrix is much more effective.

Shingrix was approved in October 2017 for adults ages 50 and older. In 2018, the vaccine received a preferential recommendation by the CDC’s Advisory Committee on Immunization Practices over the live shingles vaccine, which officially left the market in 2020.

If you never get chickenpox, you will never develop shingles. Of course, we have a vaccine for that: the chickenpox (or varicella) vaccine.

The CDC recommends the shingles vaccine for individuals 50 years or older. Additionally, the vaccine should be given to individuals 19 years or older with a compromised immune system. Other countries have different recommendations, so check your country’s public health authority’s recommendations.

So let’s be clear about a couple of things. First, you are at risk of shingles only if you have had chickenpox. Second, children who have received the chickenpox vaccine and never had chickenpox will not be at risk for shingles as they age.

Shingles vaccine and cardiovascular outcomes study

In a paper published on 26 August 2026 in Nature Medicine, Maxime Taquet, MSc, BMBCh, PhD, University of Oxford and Oxford Health NHS Foundation Trust, England, and colleagues examined the differences in patient outcomes between those vaccinated in the 2017 season dominated by the live-attenuated shingles vaccine (Zostavax) and those vaccinated in 2018 mostly using the recombinant herpes zoster vaccine (Shingrix).

The researchers examined electronic health records and compared outcomes of adults aged≥60 years vaccinated in April through September 2017 (when 98.6% of people received Zostavax) against those vaccinated in April through September 2018 (when 93.5% of people received Shingrix).

The researchers found the following key results:

• Composite cardiovascular outcomes for restricted mean time lost (RMTL), or the expected amount of time lost due to an event within a pre-specified follow-up period, was 9%. In other words, cardiovascular-related outcomes reduced time lost by 9% for an average individual in the study.
• For ischemic heart disease, RMTL = 10%.
• For heart failure, RMTL = 12%.
• Reduction in ischemic stroke was statistically significant in men, RMTL = 12%, but not in women.

Summary

Although these results support the hypothesis that the shingles vaccine protects cardiovascular health, an observational study cannot establish causality. Further research is required to establish a causal link between the vaccine and cardiovascular outcomes.

I have written several times that the shingles vaccine does not directly improve health outcomes; it does so by preventing shingles, which can lead to worse cardiovascular outcomes.

However, Ian Jones, Professor of Virology, University of Reading, wrote:

The vaccine works by generating antibodies to a single virus protein that block or reduce virus entry, giving protection against shingles, the re-awakened form of chickenpox. While the antibodies are specific to the virus, the vaccine also includes chemicals to kick-start the immune system and it is possible that this immune jolt also clears up low-level persistent inflammation which would otherwise build to later clinical disease, including neuronal and cardiovascular disease.

Professor Jones hypothesizes that the vaccine does indeed directly protect the body against inflammation that leads to later clinical diseases like dementia and cardiovascular disease.

As I always say, the major benefit is to prevent shingles, a devastating disease. Reducing cardiovascular and dementia risks is just a huge bonus.

Citations

• Corsi-Zuelli F, Li F, Upthegrove R, Todd JA, Raman B, Harrison PJ, Taquet M. Recombinant shingles vaccination and the risk of cardiovascular events. Nat Med. 2026 Aug 26. doi: 10.1038/s41591-026-04606-0. Epub ahead of print. PMID: 42649256.

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