Cardiovascular risk in anti-VEGF treatment of neovascular age-related macular degeneration

Abstract

Objective: Assess 5-year all-cause mortality (ACM), hemorrhagic stroke, ischemic stroke, and myocardial infarction (MI) risks in nAMD patients receiving anti-VEGF injections compared with controls.

Design: Population-based retrospective cohort study using a U.S. federated health research network, containing de-identified data of 96 million patients from 1/1/2003 to 3/6/2023.

Participants: nAMD Patients with anti-VEGF injections. Controls included nAMD patients without anti-VEGF injections, non-exudative AMD patients, and patients without AMD.

Methods: Patients were identified using nAMD ICD-10 and anti-VEGF CPT codes and matched for age, sex, and comorbidities. Five-year relative risk of ACM (RR₁), hemorrhagic stroke (RR₂), ischemic stroke (RR₃), and MI (RR₄) in nAMD patients receiving anti-VEGF injections were calculated.

Results: A total of 27,609 nAMD patients (mean diagnosis age [SD], [78.2 (10.3)]) received anti-VEGF injections; 769 nAMD patients without injections (75.8 [12.2]), 27,599 non-exudative AMD patients (78.2 [10.3]), and 21,902 no-AMD patients (76.1 [10.5]) were identified. After matching, nAMD patients receiving injections did not show increased risk versus nAMD patients without injections (RR₁, 0.66; 95% CI [0.53, 0.82]), (RR₂, 1.00 [0.42, 2.38]), (RR₃, 1.70 [0.92,3.13]), (RR₄, 0.63 [0.33, 1.18]). No increased risk was found compared to non-exudative AMD patients (RR₁, 0.99 [0.95, 1.03]), (RR₂, 0.94 [0.83,1.07]), (RR₃, 1.04 [0.96, 1.12]), (RR₄, 0.99 [0.91, 1.08]). Increased risk for ACM was observed versus no-AMD patients (RR₁, 1.21 [1.15, 1.27]), but no other differences were found (RR₂, 0.81 [0.70, 0.93]), (RR₃, 1.00 [0.92, 1.09]), (RR₄, 0.986 [0.90, 1.09]).

Conclusion: Anti-VEGF injections were not associated with major cardiovascular events in nAMD patients over 5 years.