title: Cardiovascular Disease Risk Associated With the Long-term Use of Depot Medroxyprogesterone Acetate.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan. Electronic address: humapharmacist@yahoo.com.
authors.forename: Huma
authors.initials: H
authors.lastname: Dilshad
authors.affiliation: Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan.
authors.forename: Rabia Ismail
authors.initials: RI
authors.lastname: Yousuf
authors.affiliation: Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan.
authors.forename: Mohammad Harris
authors.initials: MH
authors.lastname: Shoaib
authors.affiliation: Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan.
authors.forename: Subia
authors.initials: S
authors.lastname: Jamil
authors.affiliation: Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan.
authors.forename: Humera
authors.initials: H
authors.lastname: Khatoon
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000097:blood / Q000139:chemically induced*; D016022:Case-Control Studies; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D003271:Contraceptive Agents, Female / Q000009:adverse effects*; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000009:adverse effects*; D008875:Middle Aged; D055815:Young Adult
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D003271:Contraceptive Agents, Female; D003692:Delayed-Action Preparations; D017258:Medroxyprogesterone Acetate
keywords: Cardiovascular disease; Castelli indices; Contraception; Depot medroxyprogesterone acetate; Lipid profile