Anti-VEGF Appears Safe to Continue After Cardiovascular Events

A large retrospective cohort study published in JAMA Ophthalmology found that continuing anti-VEGF therapy around the time of stroke or myocardial infarction was associated with lower all-cause mortality and no worsening of major functional outcomes. Researchers observed consistent benefits across sensitivity analyses, with no differences between anti-VEGF agents. Experts note the findings are reassuring, though residual confounding and patient selection factors should still be considered. Photo: Leo Skorin, OD. Click image to enlarge. Since its introduction, anti-VEGF for retinal disease has raised concerns regarding risk of cardiovascular events (CVEs). Age-related macular degeneration, diabetic retinopathy and retinal vascular occlusion frequently arise in patients with atherosclerotic comorbidity, and it has been shown that patients receiving anti-VEGF are prone to CVEs. If a patient were to experience a stroke or myocardial infarction (MI) while on an anti-VEGF regimen, should treatment be paused or modified? This was the question posed in a new study in which researchers sought to evaluate whether there is an association between peri-CVE anti-VEGF exposure and mortality or major functional outcomes. Their results were published last week in JAMA Ophthalmology.1 This retrospective cohort study used data from 2005 to 2025. There were 1,526 patients with stroke and anti-VEGF exposure.  In the primary 14-day prestroke to six-week poststroke analysis, anti-VEGF exposure was associated with lower all-cause mortality compared with matched controls at 90 days (3.74% vs. 9.56%; relative risk, 0.39) and one year (9.32% vs. 17.8%; RR, 0.52). Additionally, the peristroke anti-VEGF exposure group had reduced incidence of residual neurologic deficits at 90 days (4.41% vs. 6.91%; RR, 0.64) but no difference at one year (8.48% vs. 10.7%; RR, 0.79). Among patients who received anti-VEGF within 14 days before stroke, the researchers say a similarly lower mortality was observed relative to controls at 90 days (4.58% vs. 9.06%; RR, 0.51) and one year (9.17% vs. 17%; RR, 0.54). In the peri-MI cohort, anti-VEGF exposure was associated with lower all-cause mortality at three months (5.1% vs. 15.1%; RR, 0.34) and one year (13.3% vs. 23%; RR, 0.58) and lower heart failure incidence at three months (4.7% vs. 7.3%; RR, 0.65) but not one year (10.4% vs. 12%; RR, 0.87). Among those iqrth anti-VEGF exposure 14 days or less before MI, mortality remained lower in the exposed cohort at 90 days (8% vs. 16.4%; RR, 0.49) and one year (15.2% vs. 24.5%; RR, 0.62).Further, the authors wrote in their paper, “among patients who received peri-CVE anti-VEGF, agent-specific analyses revealed no difference in one-year outcomes between aflibercept, bevacizumab, ranibizumab and other anti-VEGF agents.”They concluded, “Our findings suggest that delaying anti-VEGF or modifying agent selection in the peri-CVE period may be unnecessary and that clinical decision-making can safely prioritize continued anti-VEGF therapy without modification during the peri-CVE period while preserving vision and avoiding added systemic risk.”An invited commentary on this study, also published in JAMA Ophthalmology, says these findings are good news for patients, with some caveats.2 The author wrote, “While exposure selection of two weeks before an event and four weeks after an event carefully followed published pharmacokinetic data on postinjection systemic activity of anti-VEGF agents, there may have been differences in care following CVEs.” The commentary also says that “while the authors should be commended in conducting this sensitivity analysis to reduce confounding, a question remains as to whether pre-event health status might have also influenced ophthalmic care, which in turn may have influenced outcomes.”The findings of decreased mortality and fewer neurological deficits following peri-stroke anti-VEGF, and decreased mortality and heart failure following peri-MI anti-VEGF, raise the question of whether anti-VEGF injections were actually protective. “While it is perhaps too soon to speak about a protective effect of intraocular anti-VEGF therapy on occurrence of CVEs, we welcome the results of the study,” the author wrote in JAMA Ophthalmology.The commentary continued, commending the authors for the detailed propensity score matching to reduce bias and make the comparison the most accurate thus far published. “Overall, this brings positive news for patients continuing to receive intravitreal anti-VEGF therapy following stroke or MI,” concluded the author.Click here for the journal source and here for the commentary.  Bordbar DD,Mukhtar AO, Loya A, et al. Peri-event anti-VEGF and mortality and sequelae after stroke or myocardial infarction. JAMA Ophthalmol. March 26, 2026. [Epub ahead of print.] Kozak I. Continuing intravitreal anti-VEGF after recent stroke or MI. JAMA Ophthalmol. March 26, 2026. [Epub ahead of print.] This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.