School of Medicine, Saint Louis University, 1402 South Grand, St. Louis, Missouri 63104, USA.
J Geriatr Cardiol. 2012 Sep;9(3):213-9. doi: 10.3724/SP.J.1263.2011.12011.
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.
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].
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.
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.
代谢综合征的诊断表明代谢失衡的聚集，这些失衡总的来说已被认为是心血管和全因死亡率的主要预测因素。本研究的目的是评估老年代谢综合征患者药物治疗不足和药物滥用的程度及其对预后的影响。
在一家三级医疗中心进行回顾性图表审查，共纳入 324 名年龄大于 65 岁的患者，这些患者符合国际糖尿病基金会代谢综合征诊断标准[体重指数（BMI）> 30 kg/m²，2 型糖尿病、高血压和血脂异常的诊断]。
低（≤ 5）药物负担组有 60 例（18.5%）患者，中（> 5 且≤ 10）药物负担组有 159 例（49.1%），高（> 10）药物负担组有 105 例（32.4%）。基线时，各组仅在收缩压方面存在差异。在两年的随访中，与低药物负担组相比，中药物负担组高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、糖化血红蛋白（HbA1c）和收缩压的改善显著更好，与高药物负担组相比，中药物负担组在甘油三酯、HbA1c 和收缩压方面的改善也显著更好。HDL-C 的降低是唯一与中风相关的变量。高药物负担预测住院负担。抗高血压药物的数量、吸烟史、低和高药物负担以及 HDL-C 的降低均与死亡相关。
在代谢综合征患者中，无论是药物治疗不足还是药物滥用，在重要的实验室测量和临床结果（如心肌梗死、住院和死亡）方面，都与治疗效果降低相关。
