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Dr. Roach: COVID-19 no reason to skip shingles shot

Keith Roach

Dear Dr. Roach: Is there any risk starting the two-step process for the new shingles vaccine given the COVID-19 virus? My husband had the original shingles vaccine, and he has also contracted shingles. Should he get the new vaccine? He doesn’t believe it is necessary.

— L.M.

Dear L.M.: Several people have asked whether the new shingles vaccine makes it more likely to get COVID-19. There is no evidence that it does, and I don’t see any reason it should. Vaccines stimulate the immune system to become active against a specific target — in this case, the varicella-zoster virus, which causes chickenpox and shingles. As you note, two injections are necessary.

Your husband should still get the new shingles vaccine. It’s much more effective than the first one, and people can get shingles twice. The downside of a sore arm — and maybe a day of not feeling so well and a fever — are outweighed by the benefits of reducing shingles risk.

Dear Dr. Roach: You often discuss statin drugs and beta blockers. Could you define these?

— S.M.

Dear S.M.: Statin drugs are commonly used to reduce cholesterol, but the real goal for using them is to reduce the risk of developing a heart attack or stroke. The generic names of statin drugs all end in “-statin” (such as atorvastatin or rosuvastatin). They block an enzyme in cholesterol synthesis called HMG-CoA reductase, and with this enzyme blocked, the body is less able to make its own cholesterol.

Statin drugs have other effects in cellular metabolism that may independently reduce the buildup of cholesterol in the arteries. They are more effective than other cholesterol drugs at reducing heart disease risk, even though other drugs can reduce the cholesterol levels.

Statin drugs are appropriate for people with a high risk of developing heart disease. People with existing heart disease, most people with diabetes and people with multiple risk factors — including high blood pressure, elevated cholesterol and use of tobacco — benefit most from statin drugs. Statin drugs have important side effects, especially on the muscles, so they should never be used lightly or without due consideration of the alternatives.

Beta blockers act on the beta receptor, which is present in the heart and blood vessels. The generic names of beta blockers end in “-olol” (such as metoprolol or atenolol). Their major effect is to slow down heart rate and reduce the amount that the heart contracts with each beat. Beta blockers reduce blood pressure, but are not usually used for people with elevated blood pressure alone. These dramatically reduce the amount of work the heart needs to do, and the amount of blood the heart needs, which is why beta blockers are used in most people with heart failure or with blockages in the heart.

Beta blockers can cause very slow heart rates in some people, and can make asthma worse in some people. On the other hand, they can have beneficial effects outside the heart. One beta blocker, propranolol, is effective at preventing migraine headaches for many people. Like statins, beta blockers should be used cautiously, and only after review and discussion of the potential benefits and harms.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.