June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Risk of Stroke, Myocardial Infarction, and Mortality in AMD Patients Undergoing Anti-VEGF Therapy: A Population-Based Study in Olmsted County, MN
Author Affiliations & Notes
  • Lauren A Dalvin
    Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States
  • Matthew Starr
    Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States
  • Jackson Abou Chehade
    Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States
  • Gena M Damento
    Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States
  • Maria Garcia
    Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States
  • Saumya M Shah
    Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States
  • Sophie J Bakri
    Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States
  • Raymond Iezzi
    Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States
  • Footnotes
    Commercial Relationships   Lauren Dalvin, VitreoRetinal Surgery Foundation (F); Matthew Starr, VitreoRetinal Surgery Foundation (F); Jackson Abou Chehade, None; Gena Damento, None; Maria Garcia, None; Saumya Shah, None; Sophie Bakri, None; Raymond Iezzi, VitreoRetinal Surgery Foundation (F)
  • Footnotes
    Support  Research supported by a small grant from the VitreoRetinal Surgery Foundation
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 876. doi:
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    • Get Citation

      Lauren A Dalvin, Matthew Starr, Jackson Abou Chehade, Gena M Damento, Maria Garcia, Saumya M Shah, Sophie J Bakri, Raymond Iezzi; Risk of Stroke, Myocardial Infarction, and Mortality in AMD Patients Undergoing Anti-VEGF Therapy: A Population-Based Study in Olmsted County, MN. Invest. Ophthalmol. Vis. Sci. 2017;58(8):876.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : There is insufficient evidence to draw firm conclusions regarding risk of stroke, myocardial infarction (MI), and mortality among patients treated with intravitreal anti-vascular endothelial growth factor (VEGF) therapy. To better address this, we conducted a retrospective population-based study using 3 control groups. The age-related macular degeneration (AMD) cohort is presented here.

Methods : Rochester Epidemiology Project records were reviewed to identify all patients who received at least 1 anti-VEGF injection for exudative AMD (eAMD) between 1/1/2004 and 12/31/2013. Study inclusion required a minimum follow-up period of 2 years after the start of anti-VEGF. Charts were reviewed through 12/31/2015 for patient demographics, medical history, stroke, MI, and mortality data. Kaplan-Meier analysis was used to determine the 5-year cumulative risk of stroke, MI, and death in each control group compared to the cases. To control for event risk associated with AMD itself and for changes in event rates over time, we used 3 age- and sex-matched control groups: a pre-anti-VEGF era eAMD cohort (1990-2003), a non-exudative (dry) AMD (dAMD) cohort (2004-2013), and a non-AMD cohort (2004-2013).

Results : 504 patients (183 male) received a mean of 24±21 anti-VEGF injections for eAMD between 2004 and 2013. Mean age at time of first injection was 77±10 years. Patients who received anti-VEGF had a 7% 5-year cumulative risk of stroke, 6% risk of MI, and 30% risk of death. In the anti-VEGF cohort, there was an increased 5-year risk of stroke compared to concurrent dAMD controls (7% vs. 3%, p = 0.01) but no difference compared to past time period eAMD (9%, p = 0.23) or concurrent non-AMD controls (7%, p = 0.99). There was a decreased risk of MI in the treatment cohort compared to pre-anti-VEGF era eAMD controls (6% vs. 11%, p = 0.01), likely related to changing rates over time, but no difference compared to dAMD (6%, p = 0.71) or non-AMD controls (7%, p = 0.96). There was an increased risk of 5-year mortality compared to non-AMD controls (23%, p = 0.03) but no difference compared to past time period eAMD (27%, p = 0.36) or concurrent dAMD controls (27%, p = 0.24).

Conclusions : Intravitreal anti-VEGF therapy does not appear to increase the risk of stroke, MI, or death compared to age- and sex-matched controls with similar baseline characteristics.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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