The effect of medroxyprogesterone acetate on apolipoproteins and lipoprotein(a) concentrations in postmenopausal women: a meta-analysis of randomized controlled trials.

Background and aim: In view of the favorable effect of hormone replacement therapy (HRT) on the lipid profile in postmenopausal women, and the discrepancies that exist on the effect of medroxyprogesterone acetate (MPA) on lipoprotein concentrations and cardiovascular disease (CVD) risk, we conducted this meta-analysis of randomized controlled trials (RCT) to assess the efficacy of MPA on apolipoprotein and lipoprotein(a) concentrations in healthy postmenopausal women.

Methods: A systematic search was conducted across multiple databases, including for English-language papers published up to September 2023 comparing the effect of MPA on ApoA-I, Apo-AII, and Lp(a) levels with those of a control group. A meta-analysis was conducted using a random-effects model, reporting the results as the weighted mean difference (WMD) with a 95% confidence interval (CI).

Results: The current meta-analysis included 11 publications. the comprehensive findings indicated a noteworthy reduction in ApoA-I (WMD:-8.70mg/dL,95%CI: -12.80, -4.59,P<0.001), a significant increase in Lp(a) concentrations (WMD: 1.36mg/dL, 95% CI: 0.10, 2.63, P=0.033), and a non-significant increase in ApoB concentrations (WMD: 0.57mg/dL, 95%CI: -1.25, 2.40, P=0.539) after the administration of MPA in postmenopausal women. In addition, a significant reduction in ApoB levels was identified in studies with a mean participant BMI ≥25kg/m2 (WMD: -4.94mg/dL, 95%CI: -5.71 to -4.18,P< 0.001) and a greater impact on ApoA-1 and Lp(a) levels was observed in trials with doses of 5mg/day compared with 2.5mg/day.

Conclusion: MPA administration resulted in a significant increase in Lp(a) and decrease in ApoA-I levels and a non-significant increase in ApoB levels in healthy postmenopausal women.