International Journal of Women’s Health Dovepress open access to scientific and medical research Open access Full Text article O r I g I n a l r e s e a r c H effect of hormonal contraceptives on lipid profile and the risk indices for cardiovascular disease in a ghanaian community george a asare1 Background: Hormonal contraceptives (HCs) have been shown to alter lipid profile among sheila santa1 various population groups with different patterns of dyslipidemia and cardiovascular (CV) risk. robert a ngala2 The study aimed at determining the lipid profile pattern and CV risk in a Ghanaian cohort. Bernice asiedu1 Methods: Purposive random sampling was done. Forty-seven and 19 cases were on oral Daniel afriyie3 contraceptives (OCs) and injectable contraceptives (ICs), respectively; five were on subdermal albert gB amoah4 implant. Twenty-four non-users served as controls. Biodemographic and lipid profiles were determined. Total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), low-density 1Department of Medical laboratory lipoprotein cholesterol (LDLC), and very-low-density lipid lipoprotein cholesterol (VLDLC), sciences, University of ghana school of allied Health sciences (saHs), were determined. Castelli index I and II were calculated. Korle-bu, ghana; 2Department of Results: The mean age difference between the HC and control groups was insignificant. However, Molecular Medicine, school of Medical Sciences, Kwame Nkrumah University diastolic blood pressure (BP) differences were significant (P=0.006). The body mass index of science and Technology, Kumasi, (BMI) of the OC and IC groups were significantly different from the control group (P=0.003 and ghana; 3Department of Pharmacology, P=0.008, respectively). TC levels for the control and case groups were 3.35±0.62 mmol/L and University of ghana Medical school Korle-bu, ghana; 4Department of 4.07±0.91 mmol/L, respectively (P=0.002). LDLC levels for the control and case groups were Medicine, University of ghana Medical 1.74±0.57 mmol/L and 2.38±0.84 mmol/L, respectively (P=0.003). Castelli index I (TC/HDLC) school, Korle-bu, ghana and II (LDLC/HDLC) were significantly different between the control and OC groups (P=0.026 and P=0.014, respectively). Spearman’s rho correlation showed significant influence of HC use Video abstract on TG (P=0.026), TC (P=0.000), LDLC (P=0.004), and VLDLC (P=0.026) over time. Conclusion: HC use is associated with significant increases in BMI, diastolic BP, TC, LDLC, and Castelli index I and II. These changes carry a potential risk in the development of CV disease. Keywords: oral, injectable, implant, cholesterol, body mass index Introduction Seven factors influence cardiovascular (CV) health. The presence of four ideal health behaviors: non-smoking, body mass index (BMI) ,25 kg/m2, physical activity at goal level, and diet consistent with current guideline recommendations, defines CV health. Point your SmartPhone at the code above. If you have a Three other factors that contribute to ideal CV health are untreated total cholesterol QR code reader the video abstract will appear. Or use: http://dvpr.es/1nNXEhS (TC) 200 mg/dL, untreated blood pressure (BP) 120/80 mmHg, and untreated fasting blood sugar of 100 mg/dL.1 2 correspondence: george a asare Eight CV risk factors include alcohol use, tobacco use, high BP, BMI 25 kg/m , chemical Pathology Unit, Department high cholesterol, high blood glucose, low fruit and vegetable intake, and low physi- of Medical laboratory sciences, school 2 of allied Health sciences, college of cal activity. These together account for 61% of CV disease deaths and over 75% of Health sciences, University of ghana, deaths resulting from ischemic and hypertensive heart diseases.3 One of the four major PO Box KB 143, Korle-bu, accra, ghana Tel +233 244 627 456 contributors of non-communicable diseases (NCD) causing morbidity and mortality email gasare@chs.edu.gh worldwide is CV disease (CVD). In 2008, this accounted for 31% of all global deaths, submit your manuscript | www.dovepress.com International Journal of Women’s Health 2014:6 597–603 597 Dovepress © 2014 Asare et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) http://dx.doi.org/10.2147/IJWH.S59852 License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. 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Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Powered by TCPDF (www.tcpdf.org) 1 / 1 International Journal of Women's Health downloaded from https://www.dovepress.com/ by 197.255.119.9 on 14-Jul-2018 For personal use only. asare et al Dovepress of which 80% occurred in developing countries.4 Most middle risk factors for the development of dyslipidemia and CV income countries have been affected by an increasing trend disease markers. in CVD, while the trend in high income countries is on the decline.5 study site and design Metabolic risk factors include obesity,6 hypertension, Ethical clearance (MS-ET/M.3-P 3.3/2013-2014) was type 2 diabetes, high serum cholesterol, and dyslipidemia.7 obtained from the Ethics and Protocol Review Committee of Estrogen also affects the CV system through its impact on CV the University of Ghana Medical School (UGMS). Written risk factors such as the lipid profile. Oral contraceptives (OCs) informed consent was obtained from each patient. This alter the lipid profile through the genomic pathway, in which was a community study of adult females from the Zongo estrogen receptor alterations affect hepatic apolipoprotein Community attending a Reproductive Healthcare Clinic upregulation.8 Studies in pre-menopausal women using OCs in Wa, Ghana. Subjects who were already on HCs were have shown a dose-related response in their lipid profiles. recruited. Purposive random sampling technique was used.16 Women using a 20 µg ethinyl estradiol (EE)/100 µg levonorg- The inclusion criteria were as follows: females between the estrel (LNG) OC have demonstrated reductions in high- ages of 20 and 49 years; females on OCs, ICs, and subdermal density lipoprotein cholesterol (HDLC) together with small implant (IMP) contraceptives; and females without predis- increases in low-density lipoprotein cholesterol (LDLC), and posing factors or conditions to CV disease prior to contra- triglycerides (TG), in contrast to a 30 µg EE/150 µg LNG OC.9 ceptive use. Furthermore, females who had never used any The amount of lipid alteration also depends on the delivery form of contraceptives were used as age-matched controls. route. A study on women receiving two different types of The exclusion criteria included the following: females on progestin-only pills (desogestrel 75 µg/day or LNG 30 µg/day) other forms of contraceptives other than OCs, ICs, and showed that minimal lipid profile changes occurred except for IMPs; females below 20 years and females above 49 years. decreasing trends with levels of HDLC, its subfractions, and Details of contraceptive type and hormonal content were apolipoprotein-I and -II.10 noted and later classified. Types of OCs used by participants In Ghana, most women reporting to family planning were; progesterone-only HC pill (0.035 mg norethindrone) clinics use Depo-Provera (depot medroxyprogesterone and the combined OC pill (0.03 mg EE and 0.15 mg LNG). acetate [DMPA]; Pfizer, Inc., New York, NY, USA), an The mean duration of use of all HCs was 60.08 months. injectable contraceptive (IC), with a few depending on The Helsinki Declaration of 1964, with revision in October OCs. DMPA is said to increase LDLC and decrease 2008 was observed. In all, 71 cases attending the clinic were HDLC.11 A dditionally, glucose metabolism is affected sampled, alongside 24 age-matched controls. by decreasing glucose t olerance over time;12 increasing insulin resistance and decreasing beta cell function.13 Data and blood sample collection The effects of estrogen seem to be a contributive factor to A questionnaire was administered to obtain basic informa- metabolic syndrome (MS). The prevalence of MS among tion on age, duration of drug use, contraceptive type, etc. medical cases and controls in a hospital in Ghana was Anthropometric measurement was obtained by measuring 54% and 18%, respectively, with the prevalence increasing height using a portable stadiometer (Seca GmbH & Co, KG, with advancing age, using the Adult Treatment Panel III Hamburg, Germany). Height was recorded to the nearest (ATPIII) criteria.14 In another study, the overall prevalence 0.1 cm, with subjects barefooted. Weight was measured of MS as measured by the International Diabetic Federa- using a Seca 770 floor digital scale to the nearest 0.1 kg, tion (IDF) and ATPIII criteria were 35.9% and 15.0%, with subjects in minimum clothing. BMI was computed as respectively, among rural Ghanaians.15 Hypertension and (weight [kg])/(height [m])2. BP was measured three times central obesity were the two components with the highest on the left arm with a 5-minute break in between using the frequency among individuals with MS. However, the Omron 705 CP oscillometric monitor (Kyoto, Japan). The impact of ICs and OCs on obesity, MS, and CV disease mean of the three measurements was used. Cases with BP is not known nationally. readings $140/90 mmHg were regarded as hypertensive. Three milliliter blood samples were taken from all subjects Materials and methods into gel separator tubes. After clotting, blood samples were The study aimed at determining whether hormonal contra- centrifuged at 3,000 rpm for 10 minutes. Serum was aliquoted ceptive (HC) use among Ghanaian women produced any into Eppendorf tubes and stored at −20°C until use. 598 submit your manuscript | www.dovepress.com International Journal of Women’s Health 2014:6 Dovepress Powered by TCPDF (www.tcpdf.org) 1 / 1 International Journal of Women's Health downloaded from https://www.dovepress.com/ by 197.255.119.9 on 14-Jul-2018 For personal use only. Dovepress Hormonal contraceptive use and lipid profile in Ghanaian women Biochemical analysis Table 1 Patient characteristics, including physical age (years); TC, HDLC, LDLC, TG, and very-low-density lipoprotein menarche age (years); duration of contraceptive use (months); blood pressure profile (mmHg); BMI (kg/m2); lipid profile cholesterol (VLDLC) tests were conducted using Biosystem (mmol/L) CV risk indices of the control group and the case group kits on an A25 Biosystem autoanalyzer (Barcelona, Spain). (hormonal contraceptive group) Test parameter Control group Case group P-value statistical analysis (n=24) (n=71) SPSS software (v20.0; IBM Corporation, Armonk, NY, Physical age (years) 29.25±8.09 30.93±5.84 0.522 USA) was used for data management and statistical Menarche age (years) 16.07±2.56 16.38±2.80 0.859 analysis. The results were expressed as mean ± standard Duration of use (months) – 60.08±8.04 – sBP (mmHg) 113.04±1.89 117.75±15.88 0.088 deviation. Differences in continuous data were compared DBP (mmHg) 68.75±1.81 78.80±14.02 0.006* using Student’s t-test (two groups) and one-way analysis of BMI (kg/m2) 21.73±0.75 25.34±4.4 0.001* variance (ANOVA; three or more groups) followed by the TC (mmol/L) 3.35±0.62 4.07±0.91 0.002* Bonferroni post-hoc test. Relationships between variables TG (mmol/L) 0.66±0.24 0.81±0.44 0.466 were ascertained by Spearman’s correlation coefficient. HDLC (mmol/L) 1.31±0.25 1.33±0.34 0.768 LDLC (mmol/L) 1.74±0.57 2.38±0.84 0.003*All results were considered significant at the 5% level of VLDLC (mmol/L) 0.31±0.11 0.37±0.20 0.466 probability. TC/HDLCa 2.63±0.13 3.22±0.99 0.300 LDLC/HDLCb 1.39±0.56 1.92±0.86 0.018* Results Log (TG/HDLC)c −0.33±0.25 −0.25±0.25 0.393 The age range of cases was 20–49 years and that of the con- Notes: aCastelli risk index I; bCastelli risk index II; catherogenic risk index; *P,0.05; trols, 20–47 years. The mean ages of the two groups were reference intervals: Tc =3.60–6.20 mmol/L; TGs =0.40–2.25 mmol/L; direct HDlc =1.03–1.55 mmol/L; LDLC = 0–3.90 mmol/L; VLDLC ,0.65 mmol/L; Castelli 30.93±5.84 years (cases) and 29.25±8.09 years ( control) risk =0.00–4.40; blood pressure =110/70 mmHg; BMI (kg/m2) ,18.5 (underweight), and were not statistically significantly different. Of the 18.5–24.9 (normal weight), 25 (obesity); atherogenic risk index: ,0.11 (low risk), 0.11–0.21 (intermediate risk), 0.21 (increased risk). cases, 19 were on OCs (progesterone-only pill [0.035 mg Abbreviations: BMI, body mass index; CV, cardiovascular; DBP, diastolic blood pressure; HDlc, high-density lipoprotein cholesterol; lDlc, low-density lipoprotein norethindrone] or combined estrogen and p rogesterone cholesterol; sBP, systolic blood pressure; Tc, total cholesterol; Tg, triglyceride; [0.03 mg EE and 0.15 mg LNG]), 47 were on an IC VLDLC, very-low-density lipoprotein cholesterol. (Depo-Provera [150 mg medroxyprogesterone]), and five were on a subdermal contraceptive IMP (the subdermal When data was stratified according to contraceptive IMP was a progesterone-only contraceptive also known type, Castelli risk index I (TC/HDLC) and II (LDLC/ as Implanon [Merck & Co, Inc., Whitehouse Station, NJ, HDLC) were significantly different between the control and USA]. This off-white, non- biodegradable rod contains 68 mg OC group (P=0.026 and P=0.014, respectively; Table 2). etonogestrel, with a release rate of approximately 0.060–0.070 F urthermore, DBP was 68.75±1.81 mmHg (control group), mg/day in week 5–6, f ollowed by a decline to approximately whilst that of the IC and IMP groups were 78.57±1.97 mmHg 0.035–0.045 mg/day at the end of the first year). and 87.4±10.6 mmHg, respectively. DBP was statistically The mean duration of contraceptive use was 60.08 months. significantly different between the control and IC groups Prolonged bleeding (n=15), abdominal pain (n=7), and weight (P=0.019) and control and IMP groups (P=0.025; Table 2). gain (n=3) were reported by cases. For the lipid profile, significant differences were observed The BMI for the case group was 25.34±4.4 kg/m2, for TC and LDLC (control versus [vs] OC group, P=0.002; while that of the control group was 21.73±0.75 kg/m2 control group vs IC group, P=0.018). Although values (P=0.001; Table 1). Systolic BP (SBP) did not differ much; were within the normal reference intervals, increases were however, diastolic BP (DBP) was 68.75±1.81 mmHg observed with OC and IC use. Similarly, LDLC was statis- (control group) and 78.80±14.02 mmHg (case group) tically significantly different between the control and OC (P=0.006). Eight in the case group were hypertensive. groups; and control and IC groups (P=0.002 and P=0.039, Significant changes in lipid profile were observed with respectively). The BMI of the IMP group was almost the TC and LDLC. TC levels for the control and case groups same as the control group. However, the BMI of the OC group were 3.35±0.62 mmol/L and 4.07±0.91 mmol/L, respec- (26.4±1.12 kg/m2) and IC group (25.24±0.63 kg/m2) were tively (P=0.002). LDLC levels for the control and case statistically significantly different from the control group groups were 1.74±0.57 mmol/L and 2.38±0.84 mmol/L, (21.73±0.75 kg/m2; P=0.003 and P=0.008, respectively) and respectively (P=0.003; Table 1). were in the overweight range. International Journal of Women’s Health 2014:6 submit your manuscript | www.dovepress.com 599 Dovepress Powered by TCPDF (www.tcpdf.org) 1 / 1 International Journal of Women's Health downloaded from https://www.dovepress.com/ by 197.255.119.9 on 14-Jul-2018 For personal use only. asare et al Dovepress Table 2 Patient characteristics, including physical age (years), menarche age (years), duration of contraceptive use (months), blood pressure profile (mmHg), BMI (kg/m2); lipid profile (mmol/L) CV risk indices of the C, OC, IC, and IMP contraceptive groups Test parameter C (n=24) OC (n=19) IC (n=47) IMP (n=5) P-value age (years) 29.25±8.09 33.11±6.32 29.91±5.48 32.2±5.97 ns Menarche age (years) 16.07±2.56 16.38±3.56 16.81±0.52 16.2±0.73 ns Duration of use (months) – 94.63±19.62 43.64±7.85 83.4±10.6 ns sBP (mmHg) 113.04±1.89 117.32±3.71 116.49±2.13 131.20±10.35 ns DBP (mmHg) 68.75±1.81*,† 77.11±2.80 78.57±1.97* 87.4±10.6† 0.019*/0.025† BMI (kg/m2) 21.73±0.75*,† 26.4±1.12* 25.24±0.63† 22.30±0.94 0.003*/0.008† TC (mmol/L) 3.35±0.62*,† 4.33±0.96* 4.00±0.91† 3.77±0.66 0.002*/0.018† TG (mmol/L) 0.66±0.24 0.83±0.31 0.80±0.51 0.82±0.12 ns HDLC (mmol/L) 1.31±0.25 1.3±0.25 1.35±0.39 1.20±0.26 ns LDLC (mmol/L) 1.74±0.57*,† 2.65±0.94* 2.29±0.80† 2.21±0.80 0.002*/0.039† VLDLC (mmol/L) 0.31±0.11 0.38±0.14 0.36±0.23 0.37±0.06 ns TC/HDLCa 2.63±0.13* 3.46±0.27* 3.12±0.13 3.32±0.47 0.026* LDLC/HDLCb 1.39±0.56* 2.15±1.05* 1.82±0.76 2.00±0.96 0.014* Log (TG/HDLC)c −0.33±0.25 −0.22±0.22 −0.27±0.26 −0.16±0.15 ns Notes: aCastelli risk index I; bCastelli risk index II; catherogenic risk index; *,†P,0.05; reference intervals: Tc =3.60–6.20 mmol/L; TGs =0.40–2.25 mmol/L; direct HDlc =1.03–1.55 mmol/L; LDLC =0–3.90 mmol/L; VLDLC ,0.65 mmol/L; Castelli risk =0.00–4.40; blood pressure =110/70 mmHg; BMI (kg/m2) ,18.5 (underweight), 18.5–24.9 (normal weight), 25 (obesity). Abbreviations: BMI, body mass index; C, control group; CV, cardiovascular; DBP, diastolic blood pressure; HDLC, high-density lipoprotein cholesterol; IC, injectable contraceptive; IMP, implant; LDLC, low-density lipoprotein cholesterol; NS, not significant; OC, oral contraceptive; SBP, systolic blood pressure; TC, total cholesterol; TG, triglyceride; VLDLC, very-low-density lipoprotein cholesterol. Discussion had a higher risk for acute myocardial infarction (MI) and This study focused on the changes in some lipoprotein ischemic stroke than women who did have BP measure- biomarkers over time. SBP did not show any statistically ments.20 The effects of natural estrogens on hepatic metabo- significant differences among the two groups. However, lism of estrogen-dependent markers such as liver proteins DBP was statistically significantly different between the are milder than the synthetic estrogens. The 17α-ethinyl groups. When the data was stratified, statistically signifi- group on synthetic EE impedes inactivation of the entire cant differences were observed between the control group molecule, thereby leading to a stronger effect on the liver. and the IC group as well as the control group and the IMP Hence, even in non-oral administration, the impact of EE group. In a similar study, DBP was higher in OC users than is still strong on the liver production of hepatic proteins.21 in patients not using contraceptives.17 Furthermore, the DBP Because of the molecular and structural properties of EE, of OC users was significantly higher than the DBP in users which seem to resemble endogenous steroids, a high hepatic of other forms of contraceptives.17 In this study, IMP users production of angiotensinogen is attained, which makes EE had higher DBP than the OC or IC users. Women using a thousand times more powerful than endogenous steroids. OCs for more than 8 years presented higher age-adjusted This triggers the renin–angiotensin–aldosterone pathway, BP levels than women using OCs for shorter periods. An thereby causing an increase in BP.22 increase in DBP is a common feature of HC use. It is pos- TC and LDLC were significantly different in the HC group sible that withdrawal from the use of OCs can lower DBP. compared to the control group of this study. In both cases, Indeed, when this was tested in 171 women on OCs for higher results were obtained as a result of HC use. When the 6 months, both the DBP and SBP declined by 10.4 mmHg data were stratified, statistically significant differences were and 15.1 mmHg, respectively.18 However, the association between HC use and CV risk factors among 2,285 young Table 3 Influence of hormonal contraceptive use on lipid profile German girls aged 13–17 years gave relative contributions of over time HC use to be ,1% for SBP and DBP.19 Other age-related fac- Analyte TG TC LDLC VLDLC tors may be involved in BP increase. BP measurements are (mmol/L) (mmol/L) (mmol/L) (mmol/L) therefore very important and increase in DBP is regarded as P-value 0.026 0.000 0.004 0.026 a pre-hypertension marker. Five reports showed that women Note: spearman’s rho correlation. Abbreviations: lDlc, low-density lipoprotein cholesterol; Tg, triglyceride; who did not have BP measurements prior to OC initiation TC, total cholesterol; VLDLC, very-low-density lipoprotein cholesterol. 600 submit your manuscript | www.dovepress.com International Journal of Women’s Health 2014:6 Dovepress Powered by TCPDF (www.tcpdf.org) 1 / 1 International Journal of Women's Health downloaded from https://www.dovepress.com/ by 197.255.119.9 on 14-Jul-2018 For personal use only. Dovepress Hormonal contraceptive use and lipid profile in Ghanaian women seen in the OR and IC groups for both TC and LDLC when only factor that predicted weight increase. Furthermore, compared to the control group. Similar statistically significant there was no correlation between weight change and OC TC and LDLC elevations in the uninterrupted use of DMPA use or duration of OC use.32 In two separate surveys, one for 3–5 years were reported in a cohort of 140 subjects in the UK and the other in the US, 73% and 50% respec- aged 20–35 years.23 In the Toronto Nutrigenomics and Health tively, believed that OCs could lead to weight gain.33,34 Study, which involved 783 subjects, lipid metabolism bio- Although overweight was established in this study among markers were also statistically significantly higher among contraceptive users, BMI was within the pre-obese range. HC users.24 However, the pattern was different in a study It appears that HC use indirectly affects CV risk through by Okeke et al.25 In that study, 26 IC users and seven OC mechanisms involving weight gain and obesity. Obesity is users were matched with 50 non-users of reproductive age said to reduce the efficacy of contraceptives because of their in Nigeria. There was a significant change in TG and LDLC pharmacokinetic alterations. However, obesity is a well- levels; TGs increased and LDLC decreased.25 The LDLC established CV risk factor, associated with cardiometabolic results obtained in the present study were thus contrary to the risk factors6 including hypertension, type 2 diabetes, and findings of the study by Okeke et al. Furthermore, no statisti- high serum cholesterol.7 The relationship between abnormal cally significant change in TC and HDLC levels in women lipid levels and risk for coronary heart disease and MI in all on OCs was observed in that study. However, a significant regions of the world has been established.35 In this study, increase was observed in the TC of the OC group and a the atherogenic risk index was not statistically significant. slight but statistically non-significant HDLC increase in the However, the Castelli risk indices I (TC/HDLC) and II IC group of the present study. In the study by Okeke et al,25 (LDLC/HDLC) (CV risk indices) were significant in the OC HDLC was significantly increased in the IC group. In a lon- group compared to the control group. Values were lower in gitudinal study by Nessa et al,26 HDLC did not increase over the IC group but higher than the control group. Differences a 5-year period. However, in the study by Berenson et al,27 were not statistically significant in this latter group. On the HDLC increased initially (6 months) among IC users but later contrary, Okeke et al25 reported significantly lower Castelli returned to baseline after 3 years. Earlier studies carried out index I and II in the OC group. In African-American women, among 125 Kenyan women on OCs (Eugynon® [Schering OC use was associated with an increase in markers of CV AG, Berlin, Germany]: 500 µg dL-norgestrel/50 µg EE or risk.29 Similarly, Oyelola,36 in his study on Nigerian women, Microgynon® [Bayer AG, Leverkusen, Germany]: 150 µg observed higher Castelli I and II indices in OC users than in LNG plus 30 µg EE) showed a significant HDLC increase non-users, and no change in these ratios among IC users. In after twelve cycles.28 Lipid profile biomarkers are therefore this study, Spearman’s rho correlation predicted an increase disturbed with no clear pattern. in TG, TC, LDLC, and VLDLC over time (Table 3). BMI differences were statistically significantly differ- ent between contraceptive and non-contraceptive users. Conclusion The raw data showed that 23.9% of those on HCs were This study therefore suggests some potential CVD risk pre-obese. The control group and the IMP groups had with HC use through an indirect mechanism of BMI normal BMI. The OC and IC groups had mean BMI that increase, which appears to be a more consistent marker in were statistically significantly different compared to the the literature in relation to HC use than the lipid profile. control and were pre-obese by the WHO classification A longitudinal study is further suggested, as little data are (25–29.9 kg/m2). However, in an African-American group, available on the relationship between Ghanaian cohorts BMIs of the control and OC groups were in the pre-obese and HC use. and normal ranges, respectively.29 In another study, 226 DMPA users showed weight increase compared to the 603 Acknowledgment controls over a follow-up period of 6 years among Brazil- The researchers are grateful to the University of Ghana–Dan- ian women.30 S imilarly, Piccoli et al31 observed that OC ish Universities Academic Partnership, under the platform of use was a predictor for weight increase among Swedish human health (PHH) in the Building Stronger Universities women in a long-term study. However, in another long-term (BSU) program, for funding this study. longitudinal study, there was no statistically significant dif- ference in weight increase in women grouped according to Disclosure use or non-use of OC or duration of OC use. Age was the The authors report no conflicts of interest in this work. International Journal of Women’s Health 2014:6 submit your manuscript | www.dovepress.com 601 Dovepress Powered by TCPDF (www.tcpdf.org) 1 / 1 International Journal of Women's Health downloaded from https://www.dovepress.com/ by 197.255.119.9 on 14-Jul-2018 For personal use only. asare et al Dovepress References 1 7. Lubianca JN, Faccin CS, Fuchs FD. Oral contraceptives: a risk factor 1. Lloyd-Jones DM, Hong Y, Labarthe D, et al; American Heart Association for uncontrolled pressure among hypertensive women. Contraception. Strategic Planning Task Force and Statistics Committee. Defining and 2003;67(1):19–24. setting national goals for cardiovascular health promotion and disease 1 8. Lubianca JN, Moreira LB, Gus M, Fuchs FD. Stopping oral reduction: the American Heart Association’s strategic Impact Goal c ontraceptives: an effective blood pressure-lowering intervention in through 2020 and beyond. Circulation. 2010;121(4):586–613. women with hypertension. 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Contraception. 1993;47(5):445–454. 602 submit your manuscript | www.dovepress.com International Journal of Women’s Health 2014:6 Dovepress Powered by TCPDF (www.tcpdf.org) 1 / 1 International Journal of Women's Health downloaded from https://www.dovepress.com/ by 197.255.119.9 on 14-Jul-2018 For personal use only. Dovepress Hormonal contraceptive use and lipid profile in Ghanaian women International Journal of Women’s Health Dovepress Publish your work in this journal The International Journal of Women’s Health is an international, peer- a very quick and fair peer-review system, which is all easy to use. reviewed open-access journal publishing original research, reports, Visit http://www.dovepress.com/testimonials.php to read real quotes editorials, reviews and commentaries on all aspects of women’s from published authors. healthcare including gynecology, obstetrics, and breast cancer. 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