Tuñón José, Ruiz-Moreno José María, Martín-Ventura José Luis, Blanco-Colio Luis M, Lorenzo Oscar, Egido Jesús
Department of Cardiology and Vascular Research Laboratory, Fundación Jiménez Díaz and Autónoma University, Madrid, Spain.
Surv Ophthalmol. 2009 May-Jun;54(3):339-48. doi: 10.1016/j.survophthal.2009.02.003.
The neovascular form of the age-related macular degeneration (AMD) causes most cases of severe blindness. Because vascular endothelial growth factor (VEGF) plays a leading role in this disorder, several inhibitors of this molecule are being used in its treatment. However, VEGF has important functions in vascular pathophysiology. It enhances the development of collateral vessels that may supply blood to areas whose arteries are severely affected by atherosclerotic lesions. Additionally, it may promote restoration of the damaged endothelium, a vessel layer that protects against the development of atherothrombosis, and it has hypotensive effects. In contrast, VEGF may stimulate the formation of microvessels inside the atherosclerotic plaque. These vessels may become disrupted and cause intraplaque hemorrhage, stimulating disease progression. VEGF also has a role in thrombus formation. The effects of anti-VEGF therapy may therefore compromise patient safety. When administered systemically to cancer patients, the main cardiovascular adverse effects of these compounds have been thrombosis, hemorrhage and hypertension. As patients with AMD constitute a high-risk population for cardiovascular events, the safety of new anti-VEGF therapies must be assessed. In this review we analyze the effects of VEGF on atherosclerosis and the cardiovascular safety of anti-VEGF therapies in AMD.
年龄相关性黄斑变性（AMD）的新生血管形式导致了大多数严重失明病例。由于血管内皮生长因子（VEGF）在这种疾病中起主导作用，几种针对该分子的抑制剂正被用于其治疗。然而，VEGF在血管病理生理学中具有重要功能。它促进侧支血管的发育，这些侧支血管可为动脉严重受动脉粥样硬化病变影响的区域供血。此外，它可能促进受损内皮的修复，内皮是一层防止动脉粥样硬化血栓形成的血管层，并且它具有降压作用。相比之下，VEGF可能刺激动脉粥样硬化斑块内微血管的形成。这些血管可能破裂并导致斑块内出血，从而刺激疾病进展。VEGF在血栓形成中也起作用。因此，抗VEGF治疗的效果可能会危及患者安全。当全身性给予癌症患者时，这些化合物的主要心血管不良反应是血栓形成、出血和高血压。由于AMD患者是心血管事件的高危人群，必须评估新型抗VEGF治疗的安全性。在本综述中，我们分析了VEGF对动脉粥样硬化的影响以及抗VEGF治疗在AMD中的心血管安全性。
