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As if the fiery rash and painful blisters of shingles were not punishment enough, the average patient who has a resurgence of the dormant chickenpox virus known as herpes zoster — or shingles — has a higher risk of heart attack or mild stroke two decades or more after the blisters and rash recede, according to a new study.

For those who experience shingles between the ages of 18 and 40, the outlook is worse: They’re more than twice as likely to have a mild stroke and 50 percent more likely to have a heart attack than those who have not had shingles.

British researchers calculated these increased average risks after taking account of subjects’ cardiovascular risks, such as smoking, obesity, hypertension, diabetes and worrisome cholesterol readings. In other words, all other things being equal, a case of shingles in your medical history puts you at higher risk of cardiovascular disease.

Writing in the journal Neurology, the British authors of the latest report say the findings strengthen the suspicion that once unleashed as shingles, the herpes zoster virus may plant seeds of destruction in some of the body’s blood vessels that could take years to wreak havoc.

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They suggest that herpes zoster may be an underappreciated contributor to the incidence of cardiovascular disease in a population. For untold numbers, they suggest, the disease process that ends in a heart attack or stroke may have started with a mild or asymptomatic case of herpes zoster infection.

That would be a particularly sneaky trick for a virus already known for lying in wait for years to attack. Left behind when an individual is infected with wild-type chickenpox, the herpes zoster virus settles in and eludes detection by the immune system by lying dormant.

Typically decades later, when a person who had chickenpox has some dip in immune resistance, the virus travels along a sensory nerve to the skin, where it can replicate and cause painful, burning rashes and blisters. The nerve inflammation it causes can persist for weeks and even months, and for an unlucky few, the resulting nerve damage can bring unrelenting pain.

It’s been known that when the shingles virus travels along the ophthalmic branch of the trigeminal nerve in the face, and affects the area surrounding an eye, the patient has a nearly fivefold risk of stroke in the year following.

But over as many as 23 years, shingles patients followed in the current study had 14 percent more heart attacks and roughly 16 percent more mild strokes than matched subjects who had not had shingles.

The findings raise the possibility that getting the shingles vaccine could for many head off a slide toward cardiovascular disease. But other studies will be needed to test that proposition, the authors acknowledged.

In the meantime, they suggested, the shingles vaccine could be offered to any patients at risk of cardiovascular disease in a bid to reduce their risk factors. And patients who had shingles before age 40 might be treated more aggressively to drive down heart-attack and stroke risk, and urged to live a heart-healthy lifestyle.

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