Anti-VEGF Therapy–Induced Accelerated Atherosclerosis: STEMI in a Young Adult

Stefano H. Byer; Aditya Ravindra; Alex Cuskey; Yehia Saleh; Kimberly Staffey; William Zeitler

doi:10.1016/j.jaccas.2025.104351

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Anti-VEGF Therapy–Induced Accelerated Atherosclerosis: STEMI in a Young Adult

Journal article

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Peer reviewed

Anti-VEGF Therapy–Induced Accelerated Atherosclerosis: STEMI in a Young Adult

Stefano H. Byer, Aditya Ravindra, Alex Cuskey, Yehia Saleh, Kimberly Staffey and William Zeitler

JACC. Case reports, Vol.30(21), 104351

07/30/2025

DOI: 10.1016/j.jaccas.2025.104351

PMCID: PMC12441556

PMID: 40750177

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Abstract

Background: Bevacizumab is an antiangiogenic monoclonal antibody used in several primary and secondary central nervous system malignancies to reduce refractory cerebral edema. However, long-term therapy may lead to accelerated atherosclerosis through endothelial dysfunction and proteinuria-driven hyperlipidemia. Case Summary: A 27-year-old man with neurofibromatosis type 2 on long-term bevacizumab presented with progressively worsening chest pain and subsequently experienced ventricular fibrillation arrest. Emergent angiography identified an anomalous right coronary artery occlusion causing an inferior ST-segment elevation myocardial infarction and demonstrated left coronary atherosclerotic disease. He underwent successful percutaneous coronary intervention and guideline-based therapy for heart failure with reduced ejection fraction. Bevacizumab-induced endothelial injury and hyperlipidemia were implicated in premature coronary artery disease. Discussion: This case underscores the interplay between inhibition of angiogenesis and early coronary atherosclerosis, highlighting the importance of nitric oxide derangement and proteinuria-induced dyslipidemia. Clinicians must remain vigilant about cardiovascular complications in young patients on long-term bevacizumab. Take-Home Message: Bevacizumab may accelerate atherosclerosis; early detection and risk factor reduction including lipid control and tight blood pressure management are crucial.

anti-VEGF therapy

atherosclerosis

bevacizumab

congenital heart defect

dyslipidemias

myocardial infarction

ventricular fibrillation

Details

Title: Subtitle: Anti-VEGF Therapy–Induced Accelerated Atherosclerosis: STEMI in a Young Adult
Creators: Stefano H. Byer - University of Iowa
Aditya Ravindra - University of Iowa
Alex Cuskey - University of Iowa
Yehia Saleh - University of Iowa
Kimberly Staffey - University of Iowa
William Zeitler - University of Iowa
Resource Type: Journal article
Publication Details: JACC. Case reports, Vol.30(21), 104351
DOI: 10.1016/j.jaccas.2025.104351
PMID: 40750177
PMCID: PMC12441556
NLM abbreviation: JACC Case Rep
ISSN: 2666-0849
eISSN: 2666-0849
Language: English
Date published: 07/30/2025
Academic Unit: Radiology; Hematology, Oncology, and Blood & Marrow Transplantation; Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984865441602771

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