Deprescribing challenges in elderly patients at high cardiovascular risk

Izmozherova N.V., Shambatov M.A., Erlish D.S., Kolnogorova Ya.R.

Ural State Medical University, Yekaterinburg, Russia

Background: Optimizing therapy in patients at extremely high cardiovascular risk requires a balance between treatment effectiveness and the risk of polypharmacy. The concept of deprescribing is considered a promising approach to reducing the potential harm of drug therapy, including in patient groups at extremely high cardiovascular risk.
Objective: Critical evaluation of the effectiveness of a personalized approach to reducing polypharmacy by adapting treatment regimens with lipid-lowering agents, proton pump inhibitors, antihypertensive agents, and dual antiplatelet therapy based on a review of the scientific literature with elements of a systematic analysis.
Materials and methods: A search of the PubMed and Google Scholar databases was conducted from February to April 2025. Publications published between March 2019 and March 2025 were included in the analysis; the following set of keywords was used to generate the sample: deprescribing; arterial hypertension; antihypertensives; older adults; proton pump inhibitors; rosuvastatin; atorvastatin; cardiovascular disease; DAPT; prospective study; retrospective study; placebo-controlled.
Results: A pooled analysis of data from randomized and observational studies demonstrates the safety and efficacy of controlled decrease or discontinuation of these medications with strict risk stratification and dynamic monitoring. Targeted deprescribing can lead to a reduction in the incidence of side effects, a decrease in the number of drug interactions, and an improvement in adherence to therapy; however, in some patients, drug discontinuation is associated with the risk of adverse clinical outcomes.
Conclusion: Deprescribing in patients with extremely high cardiovascular risk is a clinically valid strategy for optimizing pharmacotherapy. Safe implementation of this approach requires consideration of the potential risks of drug discontinuation, comorbidities, and the patient’s functional status, as well as dynamic monitoring.

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About the Authors

Nadezhda V. Izmozherova, Dr. Sci. (Med.), Associate Professor, Head of the Department of Pharmacology and Clinical Pharmacology, Ural State Medical University; Chief External Expert in Clinical Pharmacology of the Ministry of Health of the Sverdlovsk Region, Yekaterinburg, Russia; nadezhda_izm@mail.ru, ORCID: https://orcid.org 0000-0001-7826-9657 (corresponding author)
M.A. Shambatov, Ural State Medical University, Yekaterinburg, Russia; ORCID: https://orcid.org 0000-0001-7312-415X
D.S. Erlish, Ural State Medical University, Yekaterinburg, Russia; ORCID: https://orcid.org/0009-0000-9492-683X
Ya.R. Kolnogorova, Ural State Medical University, Yekaterinburg, Russia; ORCID: https://orcid.org/0009-0008-6042-9366

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