Should we Evaluate Lipid Profiles before Prescribing Oral Contraceptives?

Evaluation of a patient’s lipid profile before prescribing a combined oral contraceptive could be justified by the high prevalence of dyslipidemia, concludes a new study.¹

The study authors, who are affiliated with the department of gynecology and obstetrics at Jundiai School of Medicine in Sao-Paulo, Brazil, set out to evaluate the prevalence of dyslipidemia in women of reproductive age who wanted a prescription for combined oral contraceptives. The authors explain that although coronary heart disease is rare in women who use combined oral contraceptives, the major risk factor for its occurrence is dyslipidemia. The objective of this study was to better understand the prevalence of dyslipidemia and how it is associated with other known clinical risk factors to help determine whether lipid profiles would be beneficial for this patient population.

The study involved 516 women aged 18 to 40 years who sought combined oral contraceptives and had no contraindications to such method of birth control. More than half (54%) of the women had never been pregnant. The study authors defined dyslipidemia as a total cholesterol level of 200 mg/dL or greater, a high-density lipoprotein cholesterol level of less than 40 mg/dL, a triglyceride level of greater than 150 mg/dL, or a low-density lipoprotein cholesterol level of 160 mg/dL or greater. The study authors also evaluated the relevance of body mass index (BMI) and smoking status on dyslipidemia.

Overall, 33.9% of the study participants had dyslipidemia. In addition, the clinical risk factors of BMI and smoking were significantly associated with abnormal lipid profiles. These clinical risk factors had a sensitivity of 31.3% to 54% and a specificity of 41.9% to 67.7% for a diagnosis of dyslipidemia, the study authors found.

It is known that BMIs indicating overweight and obesity and the habit of smoking are known risk factors for cardiovascular problems, including dyslipidemia. However, the finding that more than one third of the patients in this study had an abnormal lipid profile is significant, said the study authors. Because BMI and smoking are modestly predictive markers for dyslipidemia, the study authors propose that attaining lipid profiles in women who are overweight or obese or in women who smoke may be justified before prescribing combined oral contraceptives.

Pertinent Points:
- It is possible that up to a third of women who have no contraindications for combined oral contraceptives have dyslipidemia.
- Because dyslipidemia is a major risk factor for coronary heart disease and women who are overweight or obese or who smoke are more likely to have dyslipidemia, obtaining lipid profiles for these women before prescribing combined oral contraceptives may help educate them about their cardiovascular health and protect them against any possible adverse effects that may occur because of their contraception choice.

References:

1. Machado RB, Bernardes CR, de Souza IM, et al. Is lipid profile determination necessary in women wishing to use oral contraceptives? Contraception. 2012:In press. Available at: http://dx.doi.org/10.1016/j.contraception.2012.12.003. Accessed December 19, 2012.