MAY 29, 2019
This study assessed the incidence of cardiac events among patients receiving intravitreal anti-VEGF for wet AMD.
This was a population-based, retrospective cohort study. Researchers used the Rochester Epidemiology Project database to identify 504 patients from Minnesota who received at least 1 intravitreal anti-VEGF injection for wet AMD between 2004 and 2013. These patients were compared with 3 age- and sex-matched control groups of patients who had no AMD (n=504), dry AMD (n=504) or wet AMD but never received anti-VEGF therapy (n=473). Kaplan-Meier analysis was used to assess the 5-year risk of myocardial infarction, stroke and death.
The 5-year cumulative risk of stroke, myocardial infarction and death was 7.2%, 6.1% and 30%, respectively. Anti-VEGF treatment did not increase the risk of stroke or myocardial infarction compared with the 3 control groups.
Multivariate analysis revealed that the risk of mortality was higher only in the wet AMD group that never received anti-VEGF therapy (HR 1.63). The risk of stroke, myocardial infarction and death did not increase among the 292 patients who received at least 3 injections during the final year of follow-up.
The main limitation is the retrospective nature of the study. The authors matched patients for baseline characteristics and performed a multivariate analysis to limit effects of any unequal characteristics as much as possible, but this would not have completely excluded potential confounders. The population was limited to one demographic (white) in Minnesota. The study did not sub-classify according to type of anti-VEGF agent but there may have been differences between agents. The study did not include smoking status which can impact systemic vascular mortality.
This population-based study did not identify any consistent evidence indicating that anti-VEGF therapy was associated with increased risk of stroke, myocardial infarction or death. Although this study was retrospective and additional studies are necessary, it contributes important data to support the safety of anti-VEGF therapy.