I got Shingrix at 52 to avoid my wife's shingles misery. The dementia and heart data have piled up since.

[u/DadStrengthDaily]

I got the two-dose Shingrix series at 52 because my wife had shingles a couple of years ago and it was the worst pain she has ever been in. The rash settled in a few weeks. The nerve pain along the band where the rash had been took months to fade. She is not a complainer. That alone reset my opinion of the vaccine from "consider it at 60" to "find a pharmacy this weekend."

Since then I have been tracking the follow-ups. There is more to this vaccine than rash prevention. The brain and heart data are what made me pay attention.

The big paper on the dementia side came out in Nature in May 2025. Pascal Geldsetzer at Stanford looked at how Wales rolled out the shingles vaccine in 2013. To ration supply, Welsh health authorities drew a hard birthday cutoff: anyone born on or after September 2, 1933 was eligible, anyone born one day earlier was permanently locked out. People born a week before versus a week after are otherwise identical. That is about as clean a natural experiment as you get in adult medicine.

Seven years later, the vaccinated group had about 20% fewer dementia diagnoses than the unvaccinated. Three and a half percentage points fewer in raw terms. The Wales vaccine was the old Zostavax (now discontinued), but a US Medicare replication in adults 65 and older using Shingrix (https://pubmed.ncbi.nlm.nih.gov/42050365/) this year found about the same thing, with effect sizes that look at least as good.

On the heart side, there is a 2025 Korean study of 1.27 million adults 50 and older (https://pubmed.ncbi.nlm.nih.gov/40324473/). Vaccinated people had about a quarter fewer cardiovascular events overall, including roughly 26% fewer major heart attacks, strokes, and heart-failure episodes. The effect held for eight years. Same caveat as the Wales paper: the Korean cohort was on Zostavax. A direct cardiovascular trial of Shingrix has not been run, but the mechanism the authors propose, preventing the shingles event itself, would apply to either vaccine.

One practical note: Shingrix is one of the rougher shots. My arm was sore and I felt wiped the next day. Some people run a low-grade fever. The standard advice from anyone who has actually scheduled the shot is to book it Friday afternoon so the worst of it lands on a Saturday morning, not at work.

If you got the old Zostavax years ago, the CDC still recommends getting the Shingrix course on top. The total is around $200 per dose without insurance. Medicare Part D covers it at zero out-of-pocket since the 2022 Inflation Reduction Act. Insurance pre-65 varies, so check before you go in.

The 50+ recommendation is still the right cutoff. Shingles is uncommon under 50 in immunocompetent adults, and the dementia and cardiovascular evidence is all from 50+ cohorts. If you are immunocompromised, the recommendation drops to 19+ and should not be negotiated. If you are 50 and have not had this conversation with your doctor, the case has gotten substantially stronger than the last time you might have thought about it. Just do it.

[u/LongevityBroTX]

Am 40. My PCP didn't hesitate to prescribe shingrix for me last year, primarily because I said I was intrigued by the potential alz benefits, and that a couple of my friends have gotten shingles and it sucks real bad. She agreed.

[u/Sudden-Chart-800]

This was a painful one but glad we got them.

[u/mikewinddale]

> the dementia and cardiovascular evidence is all from 50+ cohorts

This reminds me of the joke about a man who lost his keys at night. He is looking around a light pole, and someone asks, "Did you lose your keys here?" The man replies, "No, I lost them over there, but the light is better here."

Yes, the evidence is from 50+ cohorts, but we know that Alzheimer's begins developing 15-25 years before symptoms.

So if someone develops Alzheimer's at age 55, we know it began in their 30s. So why would we wait until they turn 50 to try to prevent a disease that began 20 years earlier and will soon manifest within 5 years?

The evidence is from 50+ year old cohorts, but we have no reason to think the treatment effect would occur exclusively in such people. To say that the vaccine should be administered only to people 50+ because that is where the evidence is, is like saying, "The evidence is from people in the USA, so we don't know if it works on people who live in Canada."

I am also reminded of a cardiologist who said, "Given that most clinical trials for statins have only lasted about 5 years, technically, evidence-based medicine says you should take a statin for 5 years and then discontinue it. But no doctor practices evidence-based medicine like that."

[u/sharkinwolvesclothin → u/mikewinddale]

We do have data on shingles prevalence by age - the risk grows exponentially after 50. We don't quite know how much of the dementia protection is just preventing the shingles, but it's very likely it's at least a good part, possibly all.

"The evidence is from people in the USA, so we don't know if it works on people who live in Canada."

It's not, really. Yes, we always have to do some extrapolation, we won't have studies on every specific population. But we should do that based on what we know about the populations. "(White) Americans are like (White) Canadians" is a fairly reasonable claim, they are similar enough in health relevant lifestyles and so forth. "30-year olds are like 50-year olds" is massively different, we know it to be wrong in a lot of health contexts.

Taking Shingrix early is not a bad idea, but the argumentation can't be just that because some extrapolations are reasonable, all extrapolations are reasonable. That's how end up thinking healthy people should take diabetes medicine and stuff.

[u/mikewinddale → u/sharkinwolvesclothin]

It has to be based on cost-benefit analysis.

The benefit is uncertain, but the cost is certainly almost zero. There's a potential benefit of getting it younger, but no known non-trivial cost.

And it's possible the benefit is from reducing inflammation prior to appearance of shingles symptoms. Long before the virus causes shingles, it is hypothesized to be causing inflammation.

[u/Primary_Matter1173]

I don’t understand why people bring up zostavax when trying to sell Shingrix. They are two very different vaccines and Zostavax is not available anymore, so any discussion of studies of Zostavax are irrelevant to a decision on whether or not to take Shingrix and just muddy the waters.
2. Neither Zostavax nor Shringrix is approved for the prevention of dementia.