Association of Intravitreal Anti-Vascular Endothelial Growth Factor Therapy with Risk of Stroke, Myocardial Infarction, and Death in Patients with Exudative Age-Related Macular Degeneration

Lauren A. Dalvin, Matthew R. Starr, Jackson E. Abouchehade, Gena M. Damento, Maria Garcia, Saumya M. Shah, David O. Hodge, Irene Meissner, Sophie J. Bakri, Raymond Iezzi

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Importance: Current studies assessing the risk of stroke, myocardial infarction (MI), and death in patients undergoing intravitreal anti-vascular endothelial growth factor (VEGF) therapy are inconclusive. To our knowledge, no population-based studies have been performed to examine these potential risks. Objective: To examine whether patients with exudative age-related macular degeneration (AMD) receiving intravitreal anti-VEGF injections have a higher incidence of MI, stroke, or death compared with control populations. Design, Setting, and Participants: This population-based, retrospective cohort study included 504 patients from Olmsted County, Minnesota, identified through the Rochester Epidemiology Project (REP) database as receiving at least 1 intravitreal anti-VEGF injection for exudative AMD from January 1, 2004, to December 31, 2013. Three age- and sex-matched control groups of individuals who did not receive anti-VEGF treatment and were derived from the REP database were also studied: control individuals with exudative AMD in the era before anti-VEGF (January 1, 1990, to December 31, 2003), controls with dry AMD, and controls without AMD. Data analysis was performed from September 1, 2016, to September 1, 2017. Main Outcomes and Measures: Five-year risk of stroke, MI, and death were assessed in patients compared with controls using Kaplan-Meier and multivariate analysis with Cox proportional hazards regression models. Results: The study included 504 patients (321 female [63.7%]; mean [SD] age, 76.5 [10.0] years) who received at least 1 intravitreal anti-VEGF injection for exudative AMD during the study period. Kaplan-Meier analysis revealed a 5-year risk of 7.2% for stroke, 6.1% for MI, and 30.0% for death. Patients who received anti-VEGF had no increased risk of stroke or MI compared with controls with dry AMD (n = 504), controls with exudative AMD (n = 473), or controls without AMD (n = 504). There was an increased risk of mortality compared with controls with exudative AMD in the era prior to anti-VEGF therapy but not the other control groups on multivariate analysis (hazard ratio, 1.63; 95% CI, 1.30-2.04; P <.001). Conclusions and Relevance: This population-based study revealed that intravitreal anti-VEGF therapy for exudative AMD was not associated with consistent increases in the risk of stroke, MI, or death compared with no therapy in patients with or without AMD. It appears to be likely the cardiac events these patients experience are not attributable to their anti-VEGF therapy..

Original languageEnglish (US)
JournalJAMA Ophthalmology
DOIs
StatePublished - Jan 1 2019

Fingerprint

Macular Degeneration
Vascular Endothelial Growth Factor A
Stroke
Myocardial Infarction
Therapeutics
Kaplan-Meier Estimate
Population
Injections
Epidemiology
Multivariate Analysis
Databases
Control Groups
Proportional Hazards Models
Cohort Studies
Research Design
Retrospective Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Association of Intravitreal Anti-Vascular Endothelial Growth Factor Therapy with Risk of Stroke, Myocardial Infarction, and Death in Patients with Exudative Age-Related Macular Degeneration. / Dalvin, Lauren A.; Starr, Matthew R.; Abouchehade, Jackson E.; Damento, Gena M.; Garcia, Maria; Shah, Saumya M.; Hodge, David O.; Meissner, Irene; Bakri, Sophie J.; Iezzi, Raymond.

In: JAMA Ophthalmology, 01.01.2019.

Research output: Contribution to journalArticle

Dalvin, Lauren A. ; Starr, Matthew R. ; Abouchehade, Jackson E. ; Damento, Gena M. ; Garcia, Maria ; Shah, Saumya M. ; Hodge, David O. ; Meissner, Irene ; Bakri, Sophie J. ; Iezzi, Raymond. / Association of Intravitreal Anti-Vascular Endothelial Growth Factor Therapy with Risk of Stroke, Myocardial Infarction, and Death in Patients with Exudative Age-Related Macular Degeneration. In: JAMA Ophthalmology. 2019.
@article{026277258b8a466b8a40dc6bcbd2fd66,
title = "Association of Intravitreal Anti-Vascular Endothelial Growth Factor Therapy with Risk of Stroke, Myocardial Infarction, and Death in Patients with Exudative Age-Related Macular Degeneration",
abstract = "Importance: Current studies assessing the risk of stroke, myocardial infarction (MI), and death in patients undergoing intravitreal anti-vascular endothelial growth factor (VEGF) therapy are inconclusive. To our knowledge, no population-based studies have been performed to examine these potential risks. Objective: To examine whether patients with exudative age-related macular degeneration (AMD) receiving intravitreal anti-VEGF injections have a higher incidence of MI, stroke, or death compared with control populations. Design, Setting, and Participants: This population-based, retrospective cohort study included 504 patients from Olmsted County, Minnesota, identified through the Rochester Epidemiology Project (REP) database as receiving at least 1 intravitreal anti-VEGF injection for exudative AMD from January 1, 2004, to December 31, 2013. Three age- and sex-matched control groups of individuals who did not receive anti-VEGF treatment and were derived from the REP database were also studied: control individuals with exudative AMD in the era before anti-VEGF (January 1, 1990, to December 31, 2003), controls with dry AMD, and controls without AMD. Data analysis was performed from September 1, 2016, to September 1, 2017. Main Outcomes and Measures: Five-year risk of stroke, MI, and death were assessed in patients compared with controls using Kaplan-Meier and multivariate analysis with Cox proportional hazards regression models. Results: The study included 504 patients (321 female [63.7{\%}]; mean [SD] age, 76.5 [10.0] years) who received at least 1 intravitreal anti-VEGF injection for exudative AMD during the study period. Kaplan-Meier analysis revealed a 5-year risk of 7.2{\%} for stroke, 6.1{\%} for MI, and 30.0{\%} for death. Patients who received anti-VEGF had no increased risk of stroke or MI compared with controls with dry AMD (n = 504), controls with exudative AMD (n = 473), or controls without AMD (n = 504). There was an increased risk of mortality compared with controls with exudative AMD in the era prior to anti-VEGF therapy but not the other control groups on multivariate analysis (hazard ratio, 1.63; 95{\%} CI, 1.30-2.04; P <.001). Conclusions and Relevance: This population-based study revealed that intravitreal anti-VEGF therapy for exudative AMD was not associated with consistent increases in the risk of stroke, MI, or death compared with no therapy in patients with or without AMD. It appears to be likely the cardiac events these patients experience are not attributable to their anti-VEGF therapy..",
author = "Dalvin, {Lauren A.} and Starr, {Matthew R.} and Abouchehade, {Jackson E.} and Damento, {Gena M.} and Maria Garcia and Shah, {Saumya M.} and Hodge, {David O.} and Irene Meissner and Bakri, {Sophie J.} and Raymond Iezzi",
year = "2019",
month = "1",
day = "1",
doi = "10.1001/jamaophthalmol.2018.6891",
language = "English (US)",
journal = "JAMA Ophthalmology",
issn = "2168-6165",
publisher = "American Medical Association",

}

TY - JOUR

T1 - Association of Intravitreal Anti-Vascular Endothelial Growth Factor Therapy with Risk of Stroke, Myocardial Infarction, and Death in Patients with Exudative Age-Related Macular Degeneration

AU - Dalvin, Lauren A.

AU - Starr, Matthew R.

AU - Abouchehade, Jackson E.

AU - Damento, Gena M.

AU - Garcia, Maria

AU - Shah, Saumya M.

AU - Hodge, David O.

AU - Meissner, Irene

AU - Bakri, Sophie J.

AU - Iezzi, Raymond

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Importance: Current studies assessing the risk of stroke, myocardial infarction (MI), and death in patients undergoing intravitreal anti-vascular endothelial growth factor (VEGF) therapy are inconclusive. To our knowledge, no population-based studies have been performed to examine these potential risks. Objective: To examine whether patients with exudative age-related macular degeneration (AMD) receiving intravitreal anti-VEGF injections have a higher incidence of MI, stroke, or death compared with control populations. Design, Setting, and Participants: This population-based, retrospective cohort study included 504 patients from Olmsted County, Minnesota, identified through the Rochester Epidemiology Project (REP) database as receiving at least 1 intravitreal anti-VEGF injection for exudative AMD from January 1, 2004, to December 31, 2013. Three age- and sex-matched control groups of individuals who did not receive anti-VEGF treatment and were derived from the REP database were also studied: control individuals with exudative AMD in the era before anti-VEGF (January 1, 1990, to December 31, 2003), controls with dry AMD, and controls without AMD. Data analysis was performed from September 1, 2016, to September 1, 2017. Main Outcomes and Measures: Five-year risk of stroke, MI, and death were assessed in patients compared with controls using Kaplan-Meier and multivariate analysis with Cox proportional hazards regression models. Results: The study included 504 patients (321 female [63.7%]; mean [SD] age, 76.5 [10.0] years) who received at least 1 intravitreal anti-VEGF injection for exudative AMD during the study period. Kaplan-Meier analysis revealed a 5-year risk of 7.2% for stroke, 6.1% for MI, and 30.0% for death. Patients who received anti-VEGF had no increased risk of stroke or MI compared with controls with dry AMD (n = 504), controls with exudative AMD (n = 473), or controls without AMD (n = 504). There was an increased risk of mortality compared with controls with exudative AMD in the era prior to anti-VEGF therapy but not the other control groups on multivariate analysis (hazard ratio, 1.63; 95% CI, 1.30-2.04; P <.001). Conclusions and Relevance: This population-based study revealed that intravitreal anti-VEGF therapy for exudative AMD was not associated with consistent increases in the risk of stroke, MI, or death compared with no therapy in patients with or without AMD. It appears to be likely the cardiac events these patients experience are not attributable to their anti-VEGF therapy..

AB - Importance: Current studies assessing the risk of stroke, myocardial infarction (MI), and death in patients undergoing intravitreal anti-vascular endothelial growth factor (VEGF) therapy are inconclusive. To our knowledge, no population-based studies have been performed to examine these potential risks. Objective: To examine whether patients with exudative age-related macular degeneration (AMD) receiving intravitreal anti-VEGF injections have a higher incidence of MI, stroke, or death compared with control populations. Design, Setting, and Participants: This population-based, retrospective cohort study included 504 patients from Olmsted County, Minnesota, identified through the Rochester Epidemiology Project (REP) database as receiving at least 1 intravitreal anti-VEGF injection for exudative AMD from January 1, 2004, to December 31, 2013. Three age- and sex-matched control groups of individuals who did not receive anti-VEGF treatment and were derived from the REP database were also studied: control individuals with exudative AMD in the era before anti-VEGF (January 1, 1990, to December 31, 2003), controls with dry AMD, and controls without AMD. Data analysis was performed from September 1, 2016, to September 1, 2017. Main Outcomes and Measures: Five-year risk of stroke, MI, and death were assessed in patients compared with controls using Kaplan-Meier and multivariate analysis with Cox proportional hazards regression models. Results: The study included 504 patients (321 female [63.7%]; mean [SD] age, 76.5 [10.0] years) who received at least 1 intravitreal anti-VEGF injection for exudative AMD during the study period. Kaplan-Meier analysis revealed a 5-year risk of 7.2% for stroke, 6.1% for MI, and 30.0% for death. Patients who received anti-VEGF had no increased risk of stroke or MI compared with controls with dry AMD (n = 504), controls with exudative AMD (n = 473), or controls without AMD (n = 504). There was an increased risk of mortality compared with controls with exudative AMD in the era prior to anti-VEGF therapy but not the other control groups on multivariate analysis (hazard ratio, 1.63; 95% CI, 1.30-2.04; P <.001). Conclusions and Relevance: This population-based study revealed that intravitreal anti-VEGF therapy for exudative AMD was not associated with consistent increases in the risk of stroke, MI, or death compared with no therapy in patients with or without AMD. It appears to be likely the cardiac events these patients experience are not attributable to their anti-VEGF therapy..

UR - http://www.scopus.com/inward/record.url?scp=85060984203&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060984203&partnerID=8YFLogxK

U2 - 10.1001/jamaophthalmol.2018.6891

DO - 10.1001/jamaophthalmol.2018.6891

M3 - Article

C2 - 30703203

AN - SCOPUS:85060984203

JO - JAMA Ophthalmology

JF - JAMA Ophthalmology

SN - 2168-6165

ER -