Related Experiment Video
Updated: Feb 15, 2026
In Silico Clinical Trials for Cardiovascular Disease
Published on: May 27, 2022
Deprescribing preventive cardiovascular medication in patients with predicted low cardiovascular disease risk in
Clare H Luymes1, Rosalinde K E Poortvliet2, Nan van Geloven3
1Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands. c.h.luymes@lumc.nl.
Insights
Deprescribing preventive cardiovascular medication in low-risk patients is safe short-term. Monitoring blood pressure and cholesterol is key when stopping these medications, respecting patient preferences.
Area of Science:
- Cardiology
- General Practice
- Pharmacology
Background:
- Primary prevention of cardiovascular disease (CVD) with medication may pose risks outweighing benefits.
- The safety and cost-effectiveness of deprescribing preventive cardiovascular medication in general practice are unknown.
Purpose of the Study:
- To evaluate the safety and cost-effectiveness of deprescribing preventive cardiovascular medication in patients without a strict indication for such medication.
Main Methods:
- A pragmatic cluster randomized controlled non-inferiority trial involving 46 general practices in the Netherlands.
- Followed patients aged 40-70 using antihypertensive and/or lipid-lowering drugs without CVD and with low future CVD risk for 2 years.
- Intervention involved attempting to deprescribe medication; primary outcome was the increase in predicted 10-year CVD risk.
Main Results:
- Deprescribing attempt resulted in a 2.0% increase in predicted CVD risk versus 1.9% in usual care, within the non-inferiority margin.
- Systolic and diastolic blood pressure, and total and LDL cholesterol levels were slightly higher in the deprescribing group.
- No significant differences in cost or quality-adjusted life years between groups.
Conclusions:
- Attempting to deprescribe preventive cardiovascular medication in low-CVD-risk patients is safe short-term with monitoring.
- Deprescribing can be considered, incorporating patient preferences into the decision-making process.
Background:
The use of cardiovascular medication for the primary prevention of cardiovascular disease (CVD) is potentially inappropriate when potential risks outweigh the potential benefits. It is unknown whether deprescribing preventive cardiovascular medication in patients without a strict indication for such medication is safe and cost-effective in general practice.
Methods:
In this pragmatic cluster randomised controlled non-inferiority trial, we recruited 46 general practices in the Netherlands. Patients aged 40-70 years who were using antihypertensive and/or lipid-lowering drugs without CVD and with low risk of future CVD were followed for 2 years. The intervention was an attempt to deprescribe preventive cardiovascular medication. The primary outcome was the difference in the increase in predicted (10-year) CVD risk in the per-protocol (PP) population with a non-inferiority margin of 2.5 percentage points. An economic evaluation was performed in the intention-to-treat (ITT) population. We used multilevel (generalised) linear regression with multiple imputation of missing data.
Results:
Of 1067 participants recruited between 7 November 2012 and 18 February 2014, 72% were female. Overall, their mean age was 55 years and their mean predicted CVD risk at baseline was 5%. Of 492 participants in the ITT intervention group, 319 (65%) quit the medication (PP intervention group); 135 (27%) of those participants were still not taking medication after 2 years. The predicted CVD risk increased by 2.0 percentage points in the PP intervention group compared to 1.9 percentage points in the usual care group. The difference of 0.1 (95% CI -0.3 to 0.6) fell within the non-inferiority margin. After 2 years, compared to the usual care group, for the PP intervention group, systolic blood pressure was 6 mmHg higher, diastolic blood pressure was 4 mmHg higher and total cholesterol and low-density lipoprotein-cholesterol levels were both 7 mg/dl higher (all P < 0.05). Cost and quality-adjusted life years did not differ between the groups.
Conclusions:
The results of the ECSTATIC study show that an attempt to deprescribe preventive cardiovascular medication in low-CVD-risk patients is safe in the short term when blood pressure and cholesterol levels are monitored after stopping. An attempt to deprescribe medication can be considered, taking patient preferences into consideration.
Trial Registration:
This study was registered with Dutch trial register on 20 June 2012 ( NTR3493 ).
More Related Videos
10:11Fundus Photography as a Convenient Tool to Study Microvascular Responses to Cardiovascular Disease Risk Factors in Epidemiological Studies
Published on: October 22, 2014
07:51Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis
Published on: September 26, 2018
Related Concept Videos
01:27Psychoneuroimmunology: Cardiovascular Disease
A key area of focus in PNI is the relationship between stress and coronary...
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...
01:28Imaging Studies for Cardiovascular System V: CT
01:14Overview of the Cardiovascular System
Heart
The heart is the central pump of the cardiovascular system that circulates blood throughout the body. It comprises two atria receiving the blood and two ventricles pumping blood out of the heart. Their rhythmic contractions, called heartbeats, ensure that blood flow remains continuous.
Blood Vessels
Blood...
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...