Dilshad Huma, Yousuf Rabia Ismail, Shoaib Mohammad Harris, Jamil Subia, Khatoon Humera
Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan.
Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan.
Am J Med Sci. 2016 Nov;352(5):487-492. doi: 10.1016/j.amjms.2016.08.007. Epub 2016 Aug 11.
Depot medroxyprogesterone acetate (DMPA) contraception is widely used all over the world; however, it may lead to a decrease in high-density lipoproteins and an increase in low-density lipoproteins (LDL) and triglycerides. These changes in lipid profile have a direct effect on cardiovascular disease risk. This study has been conducted to investigate the relationship between DMPA use and lipid profile, and the effect of worsening of lipid profile on fasting blood glucose. The objective of the present study is to ascertain the effects of DMPA on lipid profiles and Castelli indices, and to estimate the risk of cardiovascular disease in the women using progesterone-only methods for contraception.
This was a multicenter case-control study including females of reproductive age. A total of 893 women were selected according to inclusion and exclusion criteria described below with the age range of 19-49 years. Among these, 477 were females who were beginning DMPA for contraception whereas 416 were the matched controls of same age and socioeconomic status. The lipid profiles, Castelli indices and fasting blood sugar were evaluated before initiation of DMPA and thereafter at 3, 6, 9 and 12 months. Controls were also analyzed for the same parameters in the same manner as that of treated group. The results were analyzed by repeated measure analysis of variance followed by Tukey׳s post hoc test for the multiple comparisons.
The results showed statistically significant differences in all parameters of lipid profile, namely cholesterol (180.7 ± 38.8 versus 133.03 ± 14.8mg/dL, and P = 0.000), LDL (120.04 ± 36.2 versus 94.27 ± 19.6mg/dL, and P = 0.000), very low-density lipoprotein cholesterol (24.6 ± 10.0 versus 20.99 ± 8.66mg/dL, and P = 0.000), high-density lipoprotein (39.67 ± 3.6 versus 44.13 ± 4.22mg/dL, and P = 0.000), total cholesterol (713.05 ± 110.2 versus 569.19 ± 80.4mg/dL, and P = 0.000), triglycerides (126.33 ± 48.8 versus 99.03 ± 30.6mg/dL, and P = 0.000), Castelli index I (4.61 ± 1.2 versus 3.02 ± 0.31, and P = 0.000) and Castelli index II (3.08 ± 1.07 versus 2.13 ± 0.41, and P = 0.000) between treated and control groups, respectively. Serum glucose levels were significantly higher (P ≤ 0.001) among the cases of DMPA (84.6394 ± 7.425mg/dL) compared with that in the control (77.822 ± 7.733mg/dL).
This study clearly revealed that there is an increase in all deleterious lipid parameters and a decrease in favorable lipid measures. Hence, it can be concluded that continued use of DMPA may predispose females to the risk of cardiovascular disease in the long run.
醋酸甲羟孕酮长效避孕针（DMPA）在全球范围内广泛使用；然而，它可能导致高密度脂蛋白降低，低密度脂蛋白（LDL）和甘油三酯升高。这些血脂谱的变化对心血管疾病风险有直接影响。本研究旨在调查使用DMPA与血脂谱之间的关系，以及血脂谱恶化对空腹血糖的影响。本研究的目的是确定DMPA对血脂谱和卡斯泰利指数的影响，并评估使用单纯孕激素避孕方法的女性患心血管疾病的风险。
这是一项多中心病例对照研究，纳入了育龄女性。根据以下纳入和排除标准，共选取了893名年龄在19 - 49岁之间的女性。其中，477名女性开始使用DMPA避孕，416名是年龄和社会经济地位相匹配的对照组。在开始使用DMPA之前以及之后的3、6、9和12个月对血脂谱、卡斯泰利指数和空腹血糖进行评估。对照组也以与治疗组相同的方式对相同参数进行分析。结果通过重复测量方差分析，随后进行用于多重比较的Tukey事后检验进行分析。
结果显示，治疗组和对照组在血脂谱的所有参数上均存在统计学显著差异，即胆固醇（180.7±38.8与133.03±14.8mg/dL，P = 0.000）、LDL（120.04±36.2与94.27±19.6mg/dL，P = 0.000）、极低密度脂蛋白胆固醇（24.6±10.0与20.99±8.66mg/dL，P = 0.000）、高密度脂蛋白（39.67±3.6与44.13±4.22mg/dL，P = 0.000）、总胆固醇（713.05±110.2与569.19±80.4mg/dL，P = 0.000）、甘油三酯（126.33±48.8与99.03±30.6mg/dL，P = 0.000）、卡斯泰利指数I（4.61±1.2与3.02±0.31，P = 0.000）和卡斯泰利指数II（3.08±1.07与2.13±0.41，P = 0.000）。与对照组（77.822±7.733mg/dL）相比，DMPA使用者的血清葡萄糖水平显著更高（P≤0.001）（84.6394±7.425mg/dL）。
本研究清楚地表明，所有有害血脂参数均升高，有益血脂指标降低。因此，可以得出结论，长期持续使用DMPA可能使女性面临心血管疾病风险。
