Author + information
- Received June 28, 2015
- Accepted July 7, 2015
- Published online September 15, 2015.
- ∗Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- †Hatter Cardiovascular Institute, University College London, London, United Kingdom
- ‡London School of Hygiene and Tropical Medicine, London, United Kingdom
- §Netherhall Gardens, London, United Kingdom
- ↵∗Reprint requests and correspondence:
Dr. Desmond G. Julian, University of Newcastle upon Tyne, Flat 1, 7 Netherhall Gardens, London NW35RN, United Kingdom.
Little is known about the benefits and risks of the long-term use of cardiovascular drugs. Evidence from randomized clinical trials (RCTs) rarely goes beyond a few years of follow-up, but patients are often given continuous treatment with multiple drugs well into old age. We focus on 4 commonly used cardiovascular drug classes: aspirin, statins, beta-blockers, and angiotensin-converting enzyme inhibitors given to patients after myocardial infarction. However, the issues raised apply more broadly to all long-term medications across cardiovascular diseases and the whole of medicine. The evidence and limitations of RCTs are addressed, as well as current practice in pre-licensing trials, the increasing problems of polypharmacy (especially in the elderly), the lack of trial evidence for withdrawal of drugs, the role of regulatory authorities and other stakeholders in this challenging situation, and the potential educational solutions for the medical profession. We conclude with a set of recommendations on how to improve the situation of long-term drug use.
- cardiovascular medications
- long-term treatment
- randomized clinical trials
Dr. Rossello has received support from a Spanish Society of Cardiology research fellowship grant. Dr. Pocock has received research grants from Amgen, AstraZeneca, Biosensors, Boston Scientific, GlaxoSmithKline, Janssen, and The Medicines Company. Dr. Julian has reported that he has no relationships relevant to the contents of this paper to disclose.
- Received June 28, 2015.
- Accepted July 7, 2015.
- 2015 American College of Cardiology Foundation
- Aspirin, Statins, Beta-Blockers, and Angiotensin-Converting Inhibitors After MI
- The Knowledge Gap in Long-Term Use of Cardiovascular Drugs
- Problems With Current Practice in Pre-Licensing Trials
- Problems of Polypharmacy
- Long-Term Use of Medications and Aging
- The Need for Trials on Withdrawal of Drugs
- An Example RCT for Withdrawal of Beta-Blockers
- Responsibilities of Regulators and Other Stakeholders