Subclinical cardiovascular disease parameters after one year in new users of depot medroxyprogesterone acetate compared to copper-IUD

Abstract

Purpose: To evaluate markers of cardiovascular disease in women with normal insulin sensitivity who had recently initiated use of depot medroxyprogesterone acetate (DMPA) as a contraceptive.

Materials and methods: A prospective, non-randomised, comparative study. Data of 30 women of 18–40 years of age, with normal hyperinsulinaemic–euglycaemic clamp at baseline and body mass index (BMI) < 30, who opted to use DMPA or a copper intrauterine device (IUD) as a contraceptive, were analysed. Serum samples were collected for evaluation of the lipid and hepatic profile, C-reactive protein, TNF-α, interleukin-6, leptin/adiponectin ratio and free fatty acids; body composition was evaluated using DXA, blood pressure and carotid intima-media thickness were measured. Evaluations were performed at baseline and 12 months later. The groups were compared using repeated measures analysis of variance (ANOVA). Significance level was 5%.

Results: The mean age of the women in the DMPA and IUD group was 28.7 ± 6.5 and 28.3 ± 5.8 years, respectively; the BMI was 23.0 ± 3.4 and 24.3 ± 2.7 kg/m², respectively, in the same groups. At 12 months, triglyceride levels were higher in the DMPA group compared to the IUD group and there was an increase in apolipoprotein B-100 in relation to baseline in DMPA group; there were no other difference between the groups.

Conclusions: No clinical cardiovascular effect was found but deterioration in CV markers was observed in the first year of use of DMPA.

摘要

目的：评估近期开始用长效醋酸甲羟孕酮（DMPA）避孕的胰岛素敏感性正常的女性心血管疾病的标志物。

材料和方法：前瞻性、非随机对照研究。分析了30例18-40岁胰岛素及血糖水平位于正常基线的女性, 且选择用DMPA和宫内节育器（IUD）作为避孕用具。搜集血清标本评估血脂和肝脏形态、C反应蛋白、TNF-a、白细胞介素-6、瘦蛋白/脂肪连接蛋白比例及游离脂肪酸；采用DXA法测定体成分, 测量血压及颈动脉内膜-中膜厚度。分别于基线和12个月后进行评估。采用重复测量方差分析（ANOVA）对各组进行比较。显著性水平为5%。

结果：DMPA组女性平均年龄为28.7 ± 6.5岁, IUD组女性平均年龄为28.3 ± 5.8岁；各组的BMI分别为23.0 ± 3.4和24.3 ± 2.7kg/m²。12个月后, DMPA组甘油三酯水平明显高于IUD组, 载脂蛋白B-100相对基线有升高；两组之间无其他差异。

结论：应用DMPA的第一年未发现明显临床心血管影响, 但是CV指标有明显下降。

Keywords:

• Contraception
• depot-medroxyprogesterone acetate
• lipid metabolism
• cardiovascular disease

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

This work was supported by the Brazilian National Research Council (CNPq), the São Paulo Foundation for the Support of Research (Fundação de Amparo à Pesquisa do Estado de São Paulo - FAPESP) and by the São Paulo State Health Department (SES-SP) [FAPESP PPSUS2009/53293-0].