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المستخلص Depot medroxy-progesterone acetate (DMPA) is a widely used long acting contraceptive, given as 150 mg IM injection every 90 days. It inhibits proliferation of ovarian follicles, resulting in an-ovulation and a decrease in circulating estrogen, the later action is potentially disadvantageous to cardiovascular health especially atherosclerosis. Oxidative modification of low density lipoprotein (LDL) play a key role in the pathogenesis of atherosclerosis as it induces an immunogenic epitopes in LDL molecule and the presence of antibodies against OX-LDL has been demonstrated in human sera. Also the level of auto antibodies against OX-LDL has been taken as an index of the oxidant status of LDL. The aim of this work is to study the level of auto antibodies against oxidized low density lipoprotein and to evaluate the risk of atherosclerosis in DMPA users. Summary & Conclusions 566 This study includes forty women aged between 25-40 years. All subjects received DMPA as a method of contraception every 12 weeks for two years continuously. Non of our patients were diabetic, hypertensive or cardiac. We also excluded females with over weight, history of thromboembolism, liver disease or impairment, lipid disorders, also females with suspected malignancy and users of hormonal contraceptives in the last one year. All the studied groups were subjected to the following: a- Full history taking. b- Thorough clinical examination. c- Routine laboratory investigations. d- Estimation of serum total cholesterol. e- Estimation of serum LDL – C. f- Estimation of serum HDL- C. g- Estimation of serum triglyceride level. h- Estimation of auto antibodies against oxidized LDL by ELISA technique . The results obtained after one and two years of DMPA use were compared with the pre- treatment values and the following changes were reported: Summary & Conclusions 561 1) There was a significant increase in the mean body weight after one and two years (p- value <0.05). 2) No statistically significant change was detected in the mean systolic and diastolic blood pressure after one and two years of DMPA use 3) Significant increase in total cholesterol level after one and two years of DMPA use 4) Significant increase in LDL-C after one and two years of DMPA use. 5) Significant decrease in HDL-C after one and two years of DMPA use. 6) No significant change in triglyceride level after use of DMPA for one and two years. 7) Significant increase in TC/HDL-C index after one and two years use of DMPA. 8) LDL- C/ HDL-C shows significant increase after one and two years of DMPA use. 9) There was mild non significant increase of autoantibodies against OX- LDL-C after one year of DMPA use and a significant increase of it has occurred after two years. Summary & Conclusions 561 10) In DMPA users there was no correlation between OX-LDL auto antibodies and TC after one year but after two years there was a significant positive correlation. However significant positive correlation between OX-LDL auto antibodies and LDL- C after one and two years has been existed, while significant negative correlation between OX-LDL auto antibodies and HDL-C after two years was observed has been demonstrated. No correlation between OX- LDL auto antibodies and TG. On the other hand significant positive correlation between OX-LDL auto antibodies and weight increase after one and two years and no correlation between OX- LDL auto antibodies and blood pressure was found. Conclusions: 1- The risk of atherosclerosis was evident after one year use of DMPA and it increased with the duration of use. 2- Oxidative modification of LDL renders it immunogenic and auto antibodies against it were found in serum. Summary & Conclusions 561 3- Auto antibodies against OX-LDL can be used as a diagnostic marker of atherosclerosis. 4- The elevation in the level of OX-LDL auto antibodies may be associated with an increased extent of atherosclerosis. 5- The aforementioned data, previous and present findings of metabolic effects of DMPA may constitute an important risk factor for cardiac disease through the initiation of risk factors that have been related to insulin resistance syndrome. The findings of this study need to be confirmed by further larger studies to evaluate the real size of the risk of atherosclerosis and the role of OX-LDL auto antibodies in the pathogenesis of atherosclerosis in DMPA users. |