The need for new clinical trials of old cardiovascular drugs

While there is understandable excitement about developing new cardiovascular drugs, an unmet and equally important need is to perform new clinical trials of old medications to determine their longer-term effects and if and when they should be discontinued after years of use. Most clinical practice guideline recommendations on important care decisions are not supported by evidence from large, randomized clinical trials. Even when randomized trials conducted in the context of historical care, which makes it uncertain whether the original trial results are still relevant to current clinical practice, given evolving background therapy and changes in populations related to ageing, more comorbidities and higher levels of polypharmacy than in the historical trial populations.