Comprehensive meta-analysis of the effects of oral medroxyprogesterone acetate plus conjugated equine oestrogens on the lipid profile in women: Insights from randomized controlled trials

IF 4.4 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Clinical Investigation Pub Date : 2024-05-10 DOI:10.1111/eci.14211

Yi Lin Zhang, Lei Xie, Fen lan Wu, Xiaomei Ding, Benjamin Hernández-Wolters, Mihnea-Alexandru Găman, Hamed Kord-Varkaneh

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引用次数: 0

Abstract

Background

Menopause is associated with elevated cardiovascular risk due to the loss of the cardioprotective effect of oestrogens. Postmenopausal women are often prescribed hormone replacement therapy (HRT) in order to control menopause symptoms and correct hormone imbalances; however, HRT can impact serum lipids' concentrations. At present, data on the effect of the administration of medroxyprogesterone acetate plus conjugated equine oestrogens (MPACEE) on the lipid profile in females are uncertain, as the investigations conducted so far have produced conflicting results. Thus, we aimed to clarify the impact of MPACEE prescription on the serum lipids' values in women by means of a systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods

We employed a random-effects model based on the DerSimonian and Laird method to determine the combined estimates of the intervention's impact on the lipid profile. The computation of the weighted mean difference (WMD) and its corresponding 95% confidence interval (CI) relied on the mean and standard deviation values from both the MPACEE and control group, respectively.

Results

A total of 53 RCTs were included in the meta-analysis with 68 RCT arms on total cholesterol (TC), 70 RCT arms on low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG), and 69 RCT arms on high-density lipoprotein cholesterol (HDL-C). Administration of MPACEE resulted in a significant reduction of TC (WMD = −11.93 mg/dL; 95% CI: −13.42, −10.44; p < .001) and LDL-C (WMD = −16.61 mg/dL; 95% CI: −17.97, −15.26; p < .001) levels, and a notable increase in HDL-C (WMD = 3.40 mg/dL; 95% CI: 2.93, 3.86; p < .001) and TG (WMD = 10.28 mg/dL; 95% CI: 7.92, 12.64; p < .001) concentrations. Subgroup analysis revealed that changes in the lipid profile were influenced by several factors: body mass index (for TC, HDL-C, TG), MPACEE dosages (for TC, LDL-C, HDL-C, TG), age (for TC, LDL-C, HDL-C, TG), durations of the intervention (for TC, LDL-C, HDL-C, TG), continuous/sequential administration of MPACEE (continuous for TC; sequential for LDL-C, TG) administration of MPACEE and serum lipids' concentrations before enrolment in the RCT (for TC, LDL-C, HDL-C, TG).

Conclusions

MPACEE administration can influence serum lipids' concentrations in females by raising HDL-C and TG levels and reducing LDL-C and TC values. Therefore, postmenopausal women who suffer from hypercholesterolaemia might benefit from this type of HRT.

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口服醋酸甲羟孕酮加共轭马雌激素对女性血脂状况影响的综合荟萃分析：随机对照试验的启示。

背景：由于雌激素失去了保护心血管的作用，绝经与心血管风险升高有关。绝经后妇女通常会接受激素替代疗法（HRT），以控制更年期症状和纠正激素失衡；然而，激素替代疗法会影响血清脂质浓度。目前，关于醋酸甲羟孕酮加共轭马雌激素（MPACEE）对女性血脂的影响的数据尚不确定，因为迄今为止所进行的调查得出的结果相互矛盾。因此，我们通过对随机对照试验（RCTs）进行系统回顾和荟萃分析，旨在明确 MPACEE 处方对女性血清脂质值的影响：方法：我们采用基于 DerSimonian 和 Laird 方法的随机效应模型来确定干预对血脂状况影响的综合估计值。加权平均差（WMD）及其相应的 95% 置信区间（CI）的计算分别依赖于 MPACEE 组和对照组的平均值和标准差：共有 53 项研究纳入了荟萃分析，其中 68 项研究涉及总胆固醇（TC），70 项研究涉及低密度脂蛋白胆固醇（LDL-C）和甘油三酯（TG），69 项研究涉及高密度脂蛋白胆固醇（HDL-C）。服用 MPACEE 可显著降低 TC（WMD = -11.93 mg/dL；95% CI：-13.42, -10.44；P 结论：MPACEE 可影响血清胆固醇和甘油三酯：服用 MPACEE 可提高 HDL-C 和 TG 水平，降低 LDL-C 和 TC 值，从而影响女性的血清脂质浓度。因此，患有高胆固醇血症的绝经后女性可能会从这种类型的 HRT 中受益。

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来源期刊

European Journal of Clinical Investigation 医学-医学：内科

CiteScore

9.50

自引率

3.60%

发文量

192

审稿时长

1 months

期刊介绍： EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.