Anti vascular endothelial growth factor (VEGF) treatment and cardiovascular disease (CVD) or mortality are not linked in patients undergoing the injections for retinal vein occlusion, according to research published in Ophthalmology Retina. An increased risk of intracranial hemorrhage might be present, but cannot be reliably quantified, researchers report.
The researchers conducted a nationwide cohort study to evaluate the association between anti-VEGF treatment, cardiovascular disease, and all-cause mortality in patients with retinal vein occlusion. They leveraged data in registries that included all patients diagnosed with retinal vein occlusion in Denmark between 2012 and 2017.
The primary outcomes were hazard ratios (HR) of a composite cardiovascular disease endpoint and all-cause mortality in patients who received anti-VEGF treatment compared with those who were not treated with anti-VEGF.
A total of 7235 patients with retinal vein occlusion (median age, 71.9 years; interquartile range, 63.7-79.5; 50.1% women and 49.9% men), 3508 who were exposed to anti-VEGF and 3727 who were not exposed to anti-VEGF, were included in the study. Patients had a mean follow-up time of 3.1±2.0 years in both the composite cardiovascular disease and all-cause mortality analysis.
The researchers found no increased risk of composite cardiovascular disease (HR, 1.07; 95% confidence interval [CI], 0.89-1.29) or all-cause mortality (HR, 0.88; 95% CI, 0.77-1.00) in patients treated with anti-VEGF.
In a secondary analysis of subgroups of patients who underwent anti-VEGF treatment and had cardiovascular disease, the team observed an increased risk of intracranial hemorrhage (HR, 1.66; 95% CI, 1.02-2.71).
“Our study confirms a very high safety of the intravitreal anti-VEGF treatment in RVO patients, which have not previously been confirmed in a large-scale population-based setting,” the researchers report.
Limitations of the study included the inclusion of only patients 40 years or older and those attending hospital services and receiving anti-VEGF treatment under current clinical guidelines, those specific to the use of registries, such as no data on comorbidities, and sporadic data on the specific anti-VEGF agent used.
Frederiksen KH, Stokholm L, Möller S, et al. Vascular endothelial growth factor inhibition in retinal vein occlusion does not associate with cardiovascular morbidity and mortality. Ophthalmol Retina. Published online February 21, 2023. doi:10.1016/j.oret.2023.02.009