Chronic Use of Hormonal Contraceptives and Its Impact on Cardiovascular Risk

Aims: The purpose of the study was to observe if hormonal contraceptive use increases CV risk in women from Ghana through increasing CV RF.

Study Design: The study was longitudinal and purposive random sampling was done.

Place and Duration of Study: A community in the Upper West region of Ghana was selected. The Reproductive Healthcare Clinic which administers contraceptives was used for the study from January 2013 to January 2014.

Methodology: Seventy- one (71) cases were recruited (20-40 years). Twenty-three (23) were on an injectable contraceptive (IC), 43 on an oral contraceptive (OC), 5 on a sub-dermal implant contraceptive (IMP) and 4 switched methods from OC to IC or to IMP. After 12 months, a total of 42 remained in the study. Twenty-three (23) remained on IC, 11 on OC and 4 on IMP. Anthropometry [Body mass Index (BMI), Diastolic and Systolic Blood Pressure (DBP,SBP)], Lipid profile [Total Cholesterol (TC), High Density Lipoprotein Cholesterol (HDL), Low Density Lipoprotein (LDL), Triglycerides (TG), Very Low Density Lipoprotein (VLDL), Apolipoprotein A-1(ApoA-1), Apolipoprotein B(Apo B) and cardiovascular risk indices [Castelli index I = TC/HDL; Castelli index II = LDL/HDL; Atherosclerotic risk = (TC-HDL)/HDL; Atherogenic index of plasma = Log TG/HDL] were determined and statistically analyzed.

Results: Comparison of the studied groups showed that OC users had significantly increased DBP, BMI, TC, LDL, TG and Apo B (p<0.001, all cases). IC user also had significantly increased BP, BMI, TC, LDL, TG and Apo B (p<0.001), whilst HDL and Apo A-1 reduced significantly (p<0.001). IMP users had significantly increased BP, TC and Apo B (p<0.05). Castelli index I, atherosclerotic risk, atherogenic index of plasma, Apo B/Apo A-1 (a better predictor of coronary risk) increased significantly (p<0.001, respectively), for the OC and IC groups.

Conclusion: Chronic use of hormonal contraceptives amongst women has the tendency to cause weight gain, increase BP and dyslipidaemia. IC had the greatest cardiovascular risk.