The effect of combined oral contraception and depot medroxyprogesterone acetate on brachial flow mediated dilatation and carotid arterial distensibility and stiffness index

Abstract

To compare the brachial flow-mediated dilation (FMD), carotid distensibility and stiffness index among young healthy women users of combined oral contraception (COC), depot medroxyprogesterone acetate (DMPA) and non users of hormonal contraception (NU). Cross-sectional study. The patients were enrolled from July 2006 to April 2007: 100 young healthy women aged from 18 to 30 years, 50 NU and 50 users of hormonal contraception for at least 6 months: 25 users of COC (cyclic use of ethinylestradiol 30 μg + levonorgestrel 150 μg) and 25 users of DMPA (150 mg intramuscular every 11 to 13 weeks). All patients were evaluated in a single morning appointment after overnight fast. The clinical parameters were age, body mass index (BMI), waist, systolic and diastolic blood pressure (SBP and DBP) and heart rate (HR). The ultrasonographic evaluation included the measurement of carotid intima-media thickness (IMT), right common carotid artery diastolic and systolic diameter (to calculate carotid distensibility and stiffness index), brachial artery diameter before and after 60 seconds of a five minutes 200 mmHg forearm compression (for FMD), uterine volume and the mean volume of both ovaries (only the contralateral ovary was considered when a corpus luteum was observed). One way ANOVA and Tukey post test were used to compare means. Means and standard deviations from the three groups are shown in the table. A significant difference was only observed in FMD (6.4 ± 2.2% vs. 8.7 ± 3.4%, COC vs. NU, P<0.01; 6.2 ± 2.1% vs. 8.7 ± 3.4%, DMPA vs. NU, P<0.01), uterine volume (52.5 ± 17.3cm3 vs. 66.1 ± 18.1cm3, DMPA vs. NU, P<0.01) and ovarian volume (5.3 ± 1.9 cm3 vs. 6.7 ± 2.2 cm3, COC vs. NU, P<0.05). TableDifferences among NU, COC and DMPA groupsNUCOCDMPAAge (years)23.4 ± 3.623.7 ± 3.222.9 ± 2.8BMI (kg/m2)22.7 ± 2.922.5 ± 2.822.9 ± 2.7SBP (mmHg)110.5 ± 8.2112.5 ± 5.9112.1 ± 7.0DBP (mmHg)75.4 ± 6.774.1 ± 6.874.0 ± 6.5HR (bpm)67.4 ± 9.572.6 ± 9.570.2 ± 8.0IMT (mm)0.41 ± 0.090.43 ± 0.090.44 ± 0.09Carotid Distensibility (%mmHg−1)0.36 ± 0.090.34 ± 0.090.35 ± 0.09Stiffness Index3.25 ± 0.893.49 ± 1.063.32 ± 0.78FMD (%)8.74 ± 3.43a,b6.45 ± 2.21a6.2 ± 2.08bUterine Volume (cm3)66.1 ± 18.1c62.5 ± 20.152.5 ± 17.3cOvarian Volume (cm3)6.7 ± 2.2d5.3 ± 1.9d5.8 ± 1.4Data are given as mean ± SD; a = b = c = P<0.01; d = P<0.05. Open table in a new tab Data are given as mean ± SD; a = b = c = P<0.01; d = P<0.05. Both COC and DMPA impaired DMF while carotid distensibility and stiffness index were similar among the groups.