When cardiovascular medicines should be discontinued

Graphical Abstract Cardiovascular medicines that should either be deprescribed to prevent harm or for a lack of benefit or be switched to better alternatives. OAC, oral anticoagulation; AFIB, atrial fibrillation; ASCVD, atherosclerotic cardiovascular disease; HFrEF, heart failure with reduced ejection fraction; DPP-4, dipeptidyl peptidase-4; CVD, cardiovascular disease; DAPT, dual antiplatelet therapy; NSAID, non-steroidal anti-inflammatory drug; RAAS, renin-angiotensin-aldosterone system; AMI, acute myocardial infarction; SAMS, statin-associated muscle symptoms; ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; ACS, acute coronary syndrome. An integral component of the practice of medicine is focused on the initiation of medications, based on clinical practice guidelines and underlying trial evidence, which usually test the addition of novel medications intended for life-long use in short-term clinical trials. Much less attention is given to the question of medication discontinuation, especially after a lengthy period of treatment, during which patients age gets older and diseases may either progress or new diseases may emerge. Given the paucity of data, clinical practice guidelines offer little to no guidance on when and how to deprescribe cardiovascular medications. Such decisions are often left to the discretion of clinicians, who, together with their patients, express concern of potential adverse effects of medication discontinuation. Even in the absence of adverse effects, the continuation of medications without any proven effect may cause harm due to drug-drug interactions, the emergence of polypharmacy, and additional preventable spending to already strained health systems. Herein, several cardiovascular medications or medication classes are discussed that in the opinion of this author group should generally be discontinued, either for the prevention of potential harm, for a lack of benefit, or for the availability of better alternatives.