Polypharmacy as an ordered indicator of therapeutic complexity in a national cardiovascular prevention programme.
The prevalence of polypharmacy has been rising worldwide, most studies focuses on older adults. However, little is known about patterns and determinants of polypharmacy in middle-aged individuals engaged in structured national prevention programmes. This exploratory study examines how clinical characteristics, comorbidity structure, and system-level actions relate to increasing medication burden in participants of the Polish Prophylaxis 40 PLUS prevention programme, which focuses on the prevention and early detection of lifestyle-related (civilization) diseases, particularly cardiovascular conditions.
A cohort of 151 adults aged ≥40 years was stratified into three ordinal polypharmacy categories (5, 6, ≥7 drugs). Patients demographics, lifestyle behaviours, blood-pressure measures, ICD-10 comorbidity blocks, and indicators of medical actions were analysed. Ordinal proportional-odds regression (forward and backward stepwise selection) was performed with multimorbidity included as an adjustment covariate. Bootstrap resampling (B = 200) assessed parameter stability.
Circulatory system diseases (ICD-10 I) were consistently associated with higher odds of belonging to a higher polypharmacy category (OR 2.3-2.6). Normalisation of previously irregular heart rhythm strongly predicted higher medication burden (OR 6.0-8.4). Sensory system diseases (ICD-10 H) were also positively associated with polypharmacy, whereas nervous-system diseases (ICD-10 G) showed an inverse relationship. Higher baseline diastolic blood pressure was negatively associated with medication count (OR 0.93-0.95 per mmHg). Educational attainment demonstrated a weaker, exploratory positive association. Bootstrap analysis confirmed the robustness of the main predictors (ICD-10 I, ICD-10 G/H, heart-rhythm change, baseline DBP).
In middle-aged adults within a Polish national prevention programme, polypharmacy reflects treatment intensity and system-level complexity rather than multimorbidity alone. Cardiovascular disease, rhythm-control interventions, and multi-specialty care were associated with higher medication burden. These findings highlight the importance of integrating structured medication review, targeted deprescribing, and equitable preventive pharmacotherapy into cardiovascular prevention pathways.
A cohort of 151 adults aged ≥40 years was stratified into three ordinal polypharmacy categories (5, 6, ≥7 drugs). Patients demographics, lifestyle behaviours, blood-pressure measures, ICD-10 comorbidity blocks, and indicators of medical actions were analysed. Ordinal proportional-odds regression (forward and backward stepwise selection) was performed with multimorbidity included as an adjustment covariate. Bootstrap resampling (B = 200) assessed parameter stability.
Circulatory system diseases (ICD-10 I) were consistently associated with higher odds of belonging to a higher polypharmacy category (OR 2.3-2.6). Normalisation of previously irregular heart rhythm strongly predicted higher medication burden (OR 6.0-8.4). Sensory system diseases (ICD-10 H) were also positively associated with polypharmacy, whereas nervous-system diseases (ICD-10 G) showed an inverse relationship. Higher baseline diastolic blood pressure was negatively associated with medication count (OR 0.93-0.95 per mmHg). Educational attainment demonstrated a weaker, exploratory positive association. Bootstrap analysis confirmed the robustness of the main predictors (ICD-10 I, ICD-10 G/H, heart-rhythm change, baseline DBP).
In middle-aged adults within a Polish national prevention programme, polypharmacy reflects treatment intensity and system-level complexity rather than multimorbidity alone. Cardiovascular disease, rhythm-control interventions, and multi-specialty care were associated with higher medication burden. These findings highlight the importance of integrating structured medication review, targeted deprescribing, and equitable preventive pharmacotherapy into cardiovascular prevention pathways.
Authors
Gonos Gonos, Tradecki Tradecki, Kubielas Kubielas, Vellone Vellone, Fedorowicz Fedorowicz, Czapla Czapla, Uchmanowicz Uchmanowicz
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