Is lipid profile determination necessary in women wishing to use oral
contraceptives?
R.B. Machado, P. Fabrini, A.L. Benez, D.B. Milano, E.M.C. Maia
Department of Gynecology and Obstetrics, Faculty of Medicine, Jundiaí,
Säo Paulo, Brazil
Introduction: Although coronary heart disease in users of oral
contraceptives is rare, one of the principal risk factors for its occurrence is
dyslipidemia. The use of contraceptive pills, depending on the kind of hormone
and the dose used, may be associated with deterioration in the lipid profile and
a consequent increase in cardiovascular risk.
Objective: The aim of this study was to evaluate the prevalence of
dyslipidemia in women wishing to use oral contraceptives, and its association
with known clinical risk factors in order to evaluate the need to routinely
determine the lipid profile in this population.
Design & Methods: A total of 514 women aged 18–40 years (mean 28+6.2
years), who desired to use oral contraceptives, were evaluated in a prospective,
cross-sectional study. Prior to prescribing oral contraceptives, the following
clinical (age, body mass index, blood pressure, personal and family medical
history) and laboratory parameters (total cholesterol, HDL, LDL, triglycerides
and fasting glucose) were evaluated. Dyslipidemia was defined when isolated
cholesterol levels above 240 mg/dl were found, or when raised cholesterol levels
were associated with an increase in triglycerides, a reduction in HDL (<40 mg/dl) or when isolated triglyceride levels exceeded 200 mg/dl. Tabagism, hypertension, obesity (BMI >27.3), diabetes mellitus, and family
history of coronary heart disease and/or dyslipidemia were considered clinical
risk factors. To evaluate the association between dyslipidemia and clinical risk
factors, a 2 x 2 table was used, the odds ratio was calculated and the
Chi-square test was applied in the analysis.
Results: Some form of dyslipidemia was diagnosed in 111 patients
(21.6%). The presence of two or more risk factors was significantly associated
with the majority of diagnoses of dyslipidemia (OR=2.22; 95% CI, 1.31–3.75).
No significant association was observed between the presence of dyslipidemia and
patients with one risk factor (OR=1.44; 95% CI, 0.80–2.57). The absence of
risk factors was associated with a normal lipid profile (OR=0.54; 95% CI, 0.34–0.84).
Conclusion: Routine evaluation of the lipid profile in women wishing
to use oral contraceptives is not justified because of the low prevalence of
dyslipidemia in young people and its association with clinically identifiable
risk factors. Our results suggest that lipid profile determination should be
reserved for patients with two or more clinical risk factors.
