Background: Little information is available on the potential association between polypharmacy and risk of mortality. Objective: To determine in a population-based study whether polypharmacy is associated with increased risk of mortality in elderly persons. Methods: In this population-based, prospective study of 5,052 people aged 65 years and older (Neurological Disorders in Central Spain), current medications were recorded. Cox proportional hazards models, adjusted for sociodemographics and comorbidity factors, were used to assess the risk of death up to 13.3 years later, comparing the polypharmacy group (≥6 drugs) to those who were taking 1-5 drugs and those in a nonmedicated group (0 drugs). Results: Out of 5,052 participants, 2,550 (50.5%) died over a median follow-up of 6.5 years, including 361 (28.8%) deaths among 931 nonmedicated participants, 1,946 (51.4%) deaths among 3,787 participants taking 1-5 drugs daily, and 243 (72.8%) among 334 participants on polypharmacy. In an unadjusted Cox model, risk of mortality was increased in participants on polypharmacy [hazard ratio (HR) = 2.78, 95% confidence interval [CI]: 2.36-3.27, p < 0.001) and in those taking between 1 and 5 drugs (HR = 1.47, 95% CI: 1.31-1.64, p < 0.001) versus those who were nonmedicated (reference group). In a Cox model that adjusted for a variety of demographic factors and comorbidities, HR remained increased in participants on polypharmacy (HR = 1.83, 95% CI: 1.51-2.21, p < 0.001). Conclusion: This study provides evidencethat polypharmacy is associated with increased risk of mortality in elderly people. The extent to which polypharmacy is the proximate cause rather than a marker of this increase risk remains to be determined.

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BackgroundSystemic sclerosis is an autoimmune disease characterized by microvascular damage and fibrosis. There are several studies that shown macrovascular damage with arterial stiffness (AS) and the risk of cardiovascular complications. Carotid-femoral pulse wave velocity (CF-PWV) and augmentation index (AIx) are two competent methods to determine AS and predictors of cardiovascular disease. Association between AS and microvascular damage is unknown in systemic sclerosis patients.ObjectivesTo determine the frequency of arterial stiffness in patients with systemic sclerosis and its association with clinical manifestations.MethodsWe performed a cross-sectional study; patients with diagnosis of systemic sclerosis according to ACR/EULAR 2013 criteria were included and the control group was selected from a database of mechanical vascular service. AS was non-invasively assessed by Pulse pen device and AIx was evaluated by tonometry. Statistical analysis was done with SPSS v22 software, we calculated mean and standard deviation, for continuous variables we used Student t test, categorical variables were analyzed by using chi-square or Fisher's exact test. The correlation of AS and clinical variables was assessed with Spearman's correlation.ResultsForty seven patients were included and compared with 39 healthy subjects; mean age of study group was 48±14. vs control group 47±13.7 (p=0.08) 93% were female. Prevalence of AS was 11% vs 3% p=0.039. AS was more frequent in limited systemic sclerosis sub-group and we found correlation with abnormal capillaroscopy, Rho 0.292 p=0.04.ConclusionsArterial stiffness is more prevalent in patients with limited systemic sclerosis and association with abnormal caillaroscopy suggest that both macro and microvascular damage is present in these patients and could explain the presence of early atherosclerosis and increased risk of cardiovascular disease.References Vargas John, Lafyatis Robert. Etiology and pathogenesis of systemic sclerosis. Marc Hochberg. Texbook of Rheumatology (Sixth Edit). Elsevier, 2015. 1177–1245.Ngian G.-S., Sahhar J., Wicks I., Van Doornum, S. Arterial stiffness is increased in systemic sclerosis: A cross-sectional comparison with matched controls. Arthritis and Rheumatism 2012. 64, S301.Colaci M., Giuggioli D., Manfredi A., Sebastiani M. Aortic pulse wave velocity measurement in systemic sclerosis patients, Rheumatism 2012. 64(6), 360–367.Man A., Zhu Y., Zhang Y., Dubreuil M., Rho Y. H., Peloquin C. Choi, H. K. The risk of cardiovascular disease in systemic sclerosis: a population-based cohort study. Annals of the Rheumatic Diseases 2013. 72(7), 1188–93. Disclosure of InterestNone declared