Dear Doctor: Shingles outbreak happens due to immune system failure, not because of exposure

DEAR DR. ROACH: I am 70. I got my shingles vaccination in 2018. I took two doses of the Shingrix vaccine. I was invited to dinner at someone’s house where someone just got shingles. Am I still protected? — S.C.

ANSWER: About 99% of North Americans are immune to the varicella-zoster virus that causes chicken pox and shingles, either because they had it as a child or because they got the vaccine. Exposure to the virus, whether it was due to chicken pox or shingles, can cause chicken pox in a person who does not have immunity.

Shingles, on the other hand, does not come about due to exposure, but due to a person’s immune system failing to keep the virus (which stays in the body forever) under control. This commonly happens as we get older, under times of high stress, or if something happens to our immune system (such as chemotherapy). Shingles typically causes a rash on one side of the body and in a particular location, such as a stripe of the torso or a part of an arm or a leg.

The chicken pox you had as a child protects you from getting chicken pox again, while the shingles vaccine you got in 2018 reduces your risk of getting shingles and a recurrence of the virus. I recommend the shingles vaccine to anyone over 50 who hasn’t already had this two-dose vaccine — even if they had the old vaccine and already had shingles.

DEAR DR. ROACH: I was treated for high cholesterol and triglycerides with a statin. But I developed red skin and intense muscle aches, so I had to stop taking it. I’ve read that people of Finnish descent cannot take statins.

My doctor says that there is a shot available to take at home every two weeks. Is there evidence that I would be able to tolerate this medicine? He says that I have a 16% chance of having a stroke or a heart attack the way things are now. Is it a different medication, or is it the same medication in a different form? — R.G.

ANSWER: I did not find any information to suggest that people of Finnish descent are at a higher risk of an adverse event from a statin. Muscle aches are common with statins; they often go away, but it can definitely keep some people from taking statins. One to two percent of people are unable to take statins due to muscle aches in randomized trials, but the rate is much higher among regular people taking their prescribed statin — largely because people expect it.

A skin rash is not a common side effect of a statin, but it may be a reason not to take them. However, with a 16% risk of a heart attack, stroke or cardiac death in the next 10 years, treatment to reduce your risk is worth careful consideration.

Your doctor is recommending a medicine called a PCSK-9 inhibitor, which is not related to a statin at all. They are very effective at lowering LDL cholesterol and reducing the risk of heart disease, but they are quite expensive and, as you say, require injection.

Another option is bempedoic acid, which works similarly to statins, but it does not have an increased risk of muscle aches and is chemically unrelated to statins. So, if your red skin was due to an allergy, your risk would be low with this medication.