title: Number of medications is associated with outcomes in the elderly patient with metabolic syndrome.
abstract: BACKGROUND
  The diagnosis of metabolic syndrome indicates a clustering of metabolic imbalances which in sum have been recognized as a major predictor of cardiovascular and all-cause mortality. The aim of this study was to assess the level of under-pharmacy and poly-pharmacy and its prognostic impact in elderly patients with metabolic syndrome.
  
  
  METHODS
  Retrospective chart-review at a tertiary medical center, of 324 patients greater than 65 years of age who met the International Diabetes Foundation criteria for metabolic syndrome diagnosis [Body Mass Index (BMI) > 30 kg/m(2), diagnosis of type 2 diabetes, hypertension, and dyslipidemia].
  
  
  RESULTS
  There were 60 (18.5%) patients in the low (≤ 5) medication burden group, 159 (49.1%) in the medium (> 5 and ≤ 10) medication burden group, and 105 (32.4%) in the high (> 10) medication burden group. At baseline, the groups differed only by systolic blood pressure. At two years follow-up, the medium group had significantly better improvement in high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), HbA1c, and systolic blood pressure compared to the low medication burden group and significantly better improvement in triglycerides, Haemoglobin A1c (HbA1c) and systolic blood pressure compared to the high medication group. Decrease in HDL-C was the only variable associated with strokes. High medication burden predicted hospitalization burden. The number of anti-hypertensives, history of tobacco use, low and high medication burdens and decrease in HDL-C were all associated with death.
  
  
  CONCLUSIONS
  Both poly-pharmacy and under-pharmacy are associated with a decreased therapeutic benefit among patients with metabolic syndrome in terms of important laboratory measurements as well as clinical outcomes such as myocardial infarctions, hospitalization, and death.
authors.affiliation: School of Medicine, Saint Louis University, 1402 South Grand, St. Louis, Missouri 63104, USA.
authors.forename: Akshar Y
authors.initials: AY
authors.lastname: Patel
authors.forename: Pratik
authors.initials: P
authors.lastname: Shah
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Flaherty
keywords: Cardiovascular outcomes; Diabetes; Elderly patients; Metabolic syndrome; Mortality predictors; Poly-pharmacy