Adverse Cardiac Events in Older Patients Receiving Venlafaxine: A Population-Based Study

Objective: Venlafaxine is a commonly prescribed antidepressant, but whether its noradrenergic effects impart increased cardiovascular risk is unknown. We sought to examine the cardiac safety of venlafaxine relative to sertraline in older patients.

Method: We conducted a population-based retrospective cohort study using administrative health care databases in Ontario, Canada. We included all patients aged 66 years or older who commenced treatment with either venlafaxine or sertraline between April 1, 2000, and March 31, 2009. We used inverse probability of treatment weighting with the propensity score to account for observed systematic differences in baseline characteristics between the 2 treatment groups. The primary outcome was a composite of death or hospitalization for acute myocardial infarction or congestive heart failure (as defined by codes from the International Classification of Diseases, Ninth and Tenth Revisions) within the first year of therapy. In secondary analyses, each outcome was examined separately.

Results: We studied 48,876 patients initiated on venlafaxine and 41,238 patients initiated on sertraline. Of these, 3,966 (8.1%) and 3,707 (9.0%) experienced the primary outcome, respectively. We found no significant difference in the risk of adverse cardiac events with venlafaxine relative to sertraline (hazard ratio = 0.97; 95% CI, 0.93-1.02). Secondary analyses revealed no differences in the risk of death or acute myocardial infarction between the 2 drugs, but the risk of heart failure was unexpectedly lower among patients treated with venlafaxine (hazard ratio = 0.87; 95% CI, 0.80-0.95). We found consistent results after stratification according to preexisting cardiovascular disease.

Conclusions: As compared with sertraline, low to moderate dose venlafaxine is not associated with an increased risk of adverse cardiac events in older patients. The lower risk of heart failure among venlafaxine patients warrants further study.