Introducing Anti-Vascular Endothelial Growth Factor Therapies for AMD Did Not Raise Risk of Myocardial Infarction, Stroke, and Death.
Abstract
PURPOSE: To assess the effect of availability of anti-vascular endothelial growth
factor (VEGF) therapy on mortality and hospitalizations for acute myocardial infarction
(AMI) and stroke over a 5-year follow-up period in United States Medicare beneficiaries
newly diagnosed with exudative age-related macular degeneration (AMD) in 2006 compared
with control groups consisting of beneficiaries (1) newly diagnosed with exudative
AMD at a time when anti-VEGF therapy was not possible and (2) newly diagnosed with
nonexudative AMD. DESIGN: Retrospective cohort study. PARTICIPANTS: Beneficiaries
newly diagnosed with exudative and nonexudative AMD in 2000 and 2006 selected from
a random longitudinal sample of Medicare 5% claims and enrollment files. METHODS:
Beneficiaries with a first diagnosis of exudative AMD in 2006 were the treatment group;
beneficiaries newly diagnosed with exudative AMD in 2000 or nonexudative AMD in 2000
or 2006 were control groups. To deal with potential selection bias, we designed an
intent-to-treat study, which controlled for nonadherence to prescribed regimens. The
treatment group consisted of patients with clinically appropriate characteristics
to receive anti-VEGF injections given that the therapy is available, bypassing the
need to monitor whether treatment was actually received. Control groups consisted
of patients with clinically appropriate characteristics but first diagnosed at a time
when the therapy was unavailable (2000) and similar patients but for whom the therapy
was not clinically indicated (2000, 2006). We used a Cox proportional hazard model.
MAIN OUTCOME MEASURES: All-cause mortality and hospitalization for AMI and stroke
during follow-up. RESULTS: No statistically significant changes in probabilities of
death and hospitalizations for AMI and stroke within a 5-year follow-up period were
identified in exudative AMD beneficiaries newly diagnosed in 2006, the beginning of
widespread anti-VEGF use, compared with 2000. As an alternative to our main analysis,
which excluded beneficiaries from nonexudative AMD group who received anti-VEGF therapies
during follow-up, we performed a sensitivity analysis with this group of individuals
reincluded (11% of beneficiaries newly diagnosed with nonexudative AMD in 2006). Results
were similar. CONCLUSIONS: Introduction of anti-VEGF agents in 2006 for treating exudative
AMD has not posed a threat of increased risk of AMI, stroke, or all-cause mortality.
Type
Journal articlePermalink
https://hdl.handle.net/10161/14802Published Version (Please cite this version)
10.1016/j.ophtha.2016.06.053Publication Info
Yashkin, Arseniy P; Hahn, Paul; & Sloan, Frank A (2016). Introducing Anti-Vascular Endothelial Growth Factor Therapies for AMD Did Not Raise
Risk of Myocardial Infarction, Stroke, and Death. Ophthalmology, 123(10). pp. 2225-2231. 10.1016/j.ophtha.2016.06.053. Retrieved from https://hdl.handle.net/10161/14802.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
Collections
More Info
Show full item recordScholars@Duke
Paul Hahn
Assistant Professor of Ophthalmology
I have been extensively involved in research throughout my academic career. While
an undergraduate at Harvard College, I studied various proteins at an ultrastructural
level towards rational design of novel drugs. During medical school at the University
of Pennsylvania, I continued with basic science research studying mechanisms of action
of nuclear receptors and optimizing protocols for gene therapy. I completed my PhD
at the University of Pennsylvania studying the role of iron overload
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
Frank A. Sloan
J. Alexander McMahon Distinguished Professor Emeritus of Health Policy and Management
Professor Sloan is interested in studying the subjects of health policy and the economics
of aging, hospitals, health, pharmaceuticals, and substance abuse. He has received
funding from numerous research grants that he earned for studies of which he was the
principal investigator. His most recent grants were awarded by the Robert Wood Johnson
Foundation, the Center for Disease Control, the Pew Charitable Trust, and the National
Institute on Aging. Titles of his projects include, “Why Mature S
Arseniy Yashkin
Research Scientist, Senior
I am primarily a health outcomes researcher who specializes in cancers and chronic
age-related diseases, especially Alzheimer’s disease and type II diabetes mellitus. However,
I also write in epidemiology, demography, health economics and genetics. I am a specialist
in the analysis of administrative big health data. My main contributions to scholarship
can be summarized across three focus areas: health outcomes research, epidemiolog
Alphabetical list of authors with Scholars@Duke profiles.

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info