title: Incidence of myocardial infarction, stroke, and death in patients with age-related macular degeneration treated with intravitreal anti-vascular endothelial growth factor therapy.
abstract: OBJECTIVE
  To describe the rates of myocardial infarction (MI), stroke, and mortality in patients who have treatment with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections for age-related macular degeneration (AMD).
  
  
  METHODS
  A retrospective population linkage study.
  
  
  METHODS
  We identified patients aged 40 years and above who received treatment with intravitreal anti-VEGF injections for AMD from January 1, 2008 to December 31, 2011 at the Singapore National Eye Centre. We used a national record linkage database to identify patients who developed MI, stroke, and all-cause mortality after the first injection, excluding those with previous MI or stroke at baseline from the respective analysis. We compared rates of MI, stroke, and mortality to that of the total Singapore population.
  
  
  RESULTS
  A total of 1182 individuals had an intravitreal anti-VEGF injection included in this analysis, with the majority receiving bevacizumab (n = 1011). Overall, 19 patients developed MI, 16 developed stroke, and there were 43 mortalities, giving an age-adjusted incidence rate of 350.2 per 100 000 person-years for MI, 299.3 per 100 000 person-years for stroke, and 778.9 per 100 000 person-years for mortality. This is comparable to the weighted incidence rates of the Singapore population (427.1 per 100 000 person-years for MI, 340.4 per 100 000 person-years for stroke, and 921.3 per 100 000 person-years for mortality).
  
  
  CONCLUSIONS
  The incidence rate of MI, stroke, and death in this cohort of AMD patients treated with anti-VEGF was low, and was not significantly higher than the age-adjusted incidence rate of these events in the Singapore population.
authors.affiliation: Singapore National Eye Centre, Singapore.
authors.forename: Wei Yan
authors.initials: WY
authors.lastname: Ng
authors.affiliation: Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology Academic Clinical Program, Duke-National University of Singapore Graduate Medical School, Singapore.
authors.forename: Gavin Siew Wei
authors.initials: GS
authors.lastname: Tan
authors.affiliation: Singapore Eye Research Institute, Singapore.
authors.forename: Peng-Guan
authors.initials: PG
authors.lastname: Ong
authors.affiliation: Singapore Eye Research Institute, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology Academic Clinical Program, Duke-National University of Singapore Graduate Medical School, Singapore.
authors.forename: Ching-Yu
authors.initials: CY
authors.lastname: Cheng
authors.affiliation: Singapore Eye Research Institute, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology Academic Clinical Program, Duke-National University of Singapore Graduate Medical School, Singapore.
authors.forename: Carol Yim-Lui
authors.initials: CY
authors.lastname: Cheung
authors.affiliation: Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology Academic Clinical Program, Duke-National University of Singapore Graduate Medical School, Singapore.
authors.forename: Doric Wen Kuan
authors.initials: DW
authors.lastname: Wong
authors.affiliation: Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology Academic Clinical Program, Duke-National University of Singapore Graduate Medical School, Singapore.
authors.forename: Ranjana
authors.initials: R
authors.lastname: Mathur
authors.affiliation: National Registry of Diseases Office, Singapore.
authors.forename: Khuan Yew
authors.initials: KY
authors.lastname: Chow
authors.affiliation: Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology Academic Clinical Program, Duke-National University of Singapore Graduate Medical School, Singapore.
authors.forename: Tien Yin
authors.initials: TY
authors.lastname: Wong
authors.affiliation: Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology Academic Clinical Program, Duke-National University of Singapore Graduate Medical School, Singapore. Electronic address: gemmy.cheung.c.m@snec.com.sg.
authors.forename: Gemmy Chui Ming
authors.initials: GC
authors.lastname: Cheung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D002423:Cause of Death; D005260:Female; D006801:Humans; D015994:Incidence; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D009313:National Health Programs; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology; D020521:Stroke / Q000401:mortality*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A