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

Although coronary heart disease in users of combined oral contraceptives (COCs) is rare, one of the principal risk factors for its occurrence is dyslipidemia.

To evaluate the prevalence of dyslipidemia in women wishing to use COCs, and its association with known clinical risk factors in order to evaluate the need to determine the lipid profile in this population.

Cross-sectional study involving 516 women aged 18-40 years, 54% nulligravid, who wished to use COCs and presented no contraindications. Dyslipidemia was classified according to the National Cholesterol Educational Project Adult Treatment Panel III guidelines, which define levels of total cholesterol ≥ 200 mg/dL, high-density lipoprotein cholesterol <40 mg/dL, triglycerides >150 mg/dL, and low-density lipoprotein cholesterol ≥ 160 mg/dL as an abnormal lipid profile. The lipid profile was determined, and the association between clinical risk factors and the presence of dyslipidemia was evaluated by the chi-squared test and logistic regression. The receiver operating characteristic curve was constructed to compare body mass index (BMI) and smoking relevance for dyslipidemia.

The prevalence of dyslipidemia was 33.9%. Smoking and BMI were significantly associated with the presence of dyslipidemia, with sensitivity of 31.3-54% and specificity of 41.9-67.7% for diagnosis of dyslipidemia, respectively.

The high prevalence of dyslipidemia could justify lipid profile evaluation before prescribing a COC. BMI and smoking represent modest predictive markers for the presence of dyslipidemia in candidates for the use of combined oral contraceptives.