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Is lipid profile determination necessary in women wishing to use oral contraceptives? - contraception-esc.com

Is lipid profile determination necessary in women wishing to use oral contraceptives?

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.

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