G Ital Cardiol (Rome). 2026 Sep;27(9):637-646. doi: 10.1714/4755.47727.
ABSTRACT
Cardiovascular pharmacology over recent decades has been characterized by a dynamic and non-linear evolution, in which the introduction of new drugs has often been followed by progressive critical reassessment based on randomized controlled trials, long-term safety data, regulatory decisions, and cost-effectiveness analyses. In this context, some therapies initially considered promising have been abandoned, others have undergone a reduction in clinical use, while drugs regarded as obsolete have been reappraised in light of new evidence. Large clinical trials and observational registries have played a pivotal role in shaping these changes, often anticipating subsequent updates of international guidelines, as exemplified by the evolution of heart failure therapy from angiotensin-converting enzyme inhibitors to angiotensin receptor-neprilysin inhibitors and sodium-glucose cotransporter-2 inhibitors. This article reviews the clinical "trajectory" of selected cardiovascular drug classes and molecules, dividing them into drugs whose use has declined compared with the past widespread adoption and "revived" drugs that have gained renewed relevance thanks to new evidence. It highlights how the therapeutic fate of a drug is not determined solely by pathophysiological rationale, but rather by the complex interaction among proven clinical efficacy, safety profile, availability of more effective alternatives, regulatory factors, and evolving patterns of clinical practice. Continuous and critical reassessment of pharmacological strategies remains a cornerstone of the scientific method and a key competence of the modern cardiologist.
PMID:42643138 | DOI:10.1714/4755.47727