The effect of hormone replacement therapy and tibolone on lipoprotein (a) concentrations in postmenopausal women: A systematic review and meta-analysis

Anagnostis, Panagiotis; Galanis, Petros; Chatzistergiou, Vasileia; Stevenson, John C.; Godsland, Ian F.; Lambrinoudaki, Ιrene; Θεοδώρου, Μάμας; Goulis, Dimitrios G.

doi:10.1016/j.maturitas.2017.02.009

Cited by 66 publications

(52 citation statements)

References 70 publications

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“…If there were any (unlikely) effect of fasting status on Lp(a) and Apo B and A1 levels, this should affect cases and referents equally and attenuate the results. Similarly, we do not have data on menopausal status or statin usage, which could affect levels of Lp(a) and Apo B and A1 10. However, because age is a matching criterion, a woman in menopause is most probably matched with female referents in menopause.…”

Section: Discussionmentioning

confidence: 97%

“…Similarly, we do not have data on menopausal status or statin usage, which could affect levels of Lp(a) and Apo B and A1. 10 However, because age is a matching criterion, a woman in menopause is most probably matched with female referents in menopause. The usage of statins at the time of survey was probably very low, as the majority were surveyed before year 2000 (89%), and 98% did not report any MI before the survey.…”

Section: Limitations and Strengthsmentioning

confidence: 99%

“…Circulating levels of Lp(a) are mainly determined genetically; they are markedly stable over time in men, and they are usually not affected by diet or physical activity. In women, menopause is related to increasing levels of Lp(a) that have been related to increased risk for cardiovascular disease 10. However, Lp(a) levels may vary considerably among individuals; ≈20% of Europids have elevated Lp(a) levels, that is, >50 mg/dL (≈100‐125 nmol/L).…”

mentioning

confidence: 99%

“…In women, menopause is related to increasing levels of Lp(a) that have been related to increased risk for cardiovascular disease. 10 However, Lp(a) levels may vary considerably among individuals; %20% of Europids have elevated Lp(a) levels, that is, >50 mg/dL (%100-125 nmol/ L). The physiological role of Lp(a) is unclear, but high levels have been associated with ischemic atherosclerotic diseases such as myocardial infarction (MI) and stroke.…”

mentioning

confidence: 99%

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Lipoprotein(a) and the Apolipoprotein B/A1 Ratio Independently Associate With Surgery for Aortic Stenosis Only in Patients With Concomitant Coronary Artery Disease

Ljungberg

Holmgren

Bergdahl

et al. 2017

JAHA

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BackgroundAortic stenosis (AS) has different clinical phenotypes, including AS with or without concomitant coronary artery disease (CAD). It is unknown whether these phenotypes share the same risk factors. In particular, lipoprotein(a) [Lp(a)] and apolipoproteins (Apo) are associated with AS, but it is unknown whether these associations differ among phenotypes. In this prospective analysis we examined the impact of Lp(a) and Apo in subgroups of patients with AS.Methods and ResultsWe identified 336 patients (mean age at survey 56.7 years, 48% female) who underwent surgery for AS after a median 10.9 years (interquartile range 9.3 years), participants in 1 of 3 large population surveys. For each patient, 2 matched referents were allocated. Lp(a) and Apo were analyzed in the baseline samples. Uni‐ and multivariable logistic regression analyses were used to estimate risks related to a 1 (ln) standard deviation increase in Lp(a) and the ratio of Apo B to Apo A1 (Apo B/A1 ratio). High levels of Lp(a) predicted surgery for AS in 203 patients with concomitant CAD (odds ratio [95% confidence intervals]) (1.29 [1.07‐1.55]), but not in 132 patients without CAD (1.04 [0.83‐1.29]) in the fully adjusted model. Similarly, a high Apo B/A1 ratio predicted surgery in patients with concomitant CAD (1.43 [1.16‐1.76]) but not in those without CAD (0.87 [0.69‐1.10]).ConclusionsHigh levels of Lp(a) and a high Apo B/A1 ratio were associated with surgery for AS in patients with concomitant CAD but not in those with isolated AS. This finding may lead to a new avenue of research for targeted risk factor interventions in this population.

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Section: Discussionmentioning

confidence: 97%

Section: Limitations and Strengthsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Lipoprotein(a) and the Apolipoprotein B/A1 Ratio Independently Associate With Surgery for Aortic Stenosis Only in Patients With Concomitant Coronary Artery Disease

Ljungberg

Holmgren

Bergdahl

et al. 2017

JAHA

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“…Also, tibolone, a synthetic steroid with gestagenic and weak androgenic and estrogenic properties, resulted effective in reducing circulating Lp(a) levels (Haenggi, Riesen, & Birkhaeuser, ; Kotani et al, ). A recent meta‐analysis confirmed that hormone replacement therapy and tibolone reduced plasma Lp(a) concentrations in a large sample of postmenopausal women (Anagnostis et al, ). In line with these results, the selective estrogen receptor modulator raloxifene was reported to reduce plasma Lp(a) levels in a meta‐analysis of 1,378 post‐menopausal women (Ferretti et al, ).…”

Section: Therapeutic Modalities To Interfere With Lp(a)mentioning

confidence: 82%

Lipoprotein(a): A missing culprit in the management of athero‐thrombosis?

Ferretti

Bacchetti

Johnston

et al. 2017

Journal Cellular Physiology

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Lipoprotein(a) Lp(a) is a cholesterol-rich, LDL-like particle that is independently associated with an increased risk for ischemic heart disease, atherosclerosis, thrombosis, and stroke. Genetic variation in the Lp(a) locus and some other genes related to Lp(a) synthesis and metabolism play a critical role in regulating plasma Lp(a) levels. The pathophysiological potential of Lp(a) is related to proatherogenic and prothrombotic effects on the vasculature. Different molecular mechanisms underlying the atherothrombotic potential of Lp(a), free apolipoprotein(a), and oxidized-Lp(a) have been proposed. However, plasma Lp(a) assay is complicated by problems associated with quantification and standardization owing to the polymorphic nature of this lipoprotein. This review has focused on the physicochemical properties of Lp(a), the genetic aspects of Lp(a), the need for accurate determination of Lp(a), the synthesis, and recent findings on metabolism of Lp(a). Lastly, the patho-physiological mechanisms by which Lp(a) may increase athero-thrombosis and an overview on the therapeutic modalities to interfere with Lp(a) are summarized.

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The Role of Lipoprotein(a) in Cardiovascular Diseases

Nachtigall

2021

JAMA

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approximately 1.5 in the early morning to approximately 3 between 8 AM and 12 PM. 5 Moreover, stomach pH can change substantially with the introduction of food and liquids. Additionally, use of acid-controlling medications may elevate stomach pH levels, and individuals with Helicobacter pylori infections may have considerably higher overall stomach pH. 5 Strauss and colleagues cite another in vitro study in which gastric fluid was collected from individuals and mixed with chloramine, resulting in chloramine degradation. This study did not assess the ability of gastric fluid to inactivate chloramine when it was diluted by a meal. Moreover, the gastric fluid volume and hydrogen ion content was not assessed across the range of circadian levels. 6 Strauss and colleagues state that consumption of a large amount of food will increase the nitrites and simultaneously raise the pH, which would negate the enhanced production of NDMA. However, the food and liquid consumed could be both acidic and nitrite-rich, and consumption of a meal stimulates increased acid secretion, which may reduce pH later in the digestive process. Canned tomatoes, tomato-based sauces, and wines have a pH of approximately 3.5. Many foods and beverages have a pH ranging between 2.0 and 3.2, including berries, plums, grapes, peaches, citrus fruits, sodas, sports drinks, fruit juice, vitamin water, and vinegars. Additionally, medications, such as dabigatran with its tartaric acid core, and acetylsalicylic acid with its innate acidity and ability to directly promote proton secretion, can lower stomach pH.

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The effect of hormone replacement therapy and tibolone on lipoprotein (a) concentrations in postmenopausal women: A systematic review and meta-analysis

Abstract: HRT significantly decreases Lp(a) concentrations, with oral being more effective than transdermal estradiol. The type of HRT, dose of estrogen and addition of progestogen do not seem to modify the Lp(a)-lowering effect of HRT.

Cited by 66 publications

References 70 publications

Lipoprotein(a) and the Apolipoprotein B/A1 Ratio Independently Associate With Surgery for Aortic Stenosis Only in Patients With Concomitant Coronary Artery Disease

Lipoprotein(a) and the Apolipoprotein B/A1 Ratio Independently Associate With Surgery for Aortic Stenosis Only in Patients With Concomitant Coronary Artery Disease

Lipoprotein(a): A missing culprit in the management of athero‐thrombosis?

The Role of Lipoprotein(a) in Cardiovascular Diseases

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