The effect of tibolone treatment on apolipoproteins and lipoprotein (a) concentrations in postmenopausal women: A meta-analysis of randomized controlled trials.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 37948929 · doi:10.1016/j.ejogrb.2023.10.020
What was done
Authors conducted a systematic review and random-effects meta-analysis of randomized controlled trials (RCTs) searched across Cochrane Library, PubMed/Medline, Scopus, and Google Scholar through September 2023. They evaluated the effects of tibolone administration on apolipoprotein A-I (ApoA-I), apolipoprotein A-II (ApoA-II), apolipoprotein B (ApoB), and lipoprotein (a) in postmenopausal women, reporting weighted mean differences (WMD) with 95% confidence intervals (CI).
What was found
Across 12 publications with 13 RCT arms, tibolone treatment significantly reduced ApoA-I (9 RCT arms, WMD: -34.96 mg/dL, 95% CI: -42.44 to -27.48, P < 0.001) and lipoprotein (a) (12 RCT arms, WMD: -7.49 mg/dL, 95% CI: -12.17 to -2.81, P = 0.002). Subgroup analysis showed larger reductions in lipoprotein (a) in women aged < 60 years (WMD: -10.78 mg/dL) and with treatment duration ≤ 6 months (WMD: -15.69 mg/dL). Tibolone had no significant effect on ApoA-II (4 RCT arms, WMD: 1.32 mg/dL, 95% CI: -4.39 to 7.05, P = 0.64) or ApoB (9 RCT arms, WMD: -2.68 mg/dL, 95% CI: -20.98 to 15.61, P = 0.77).
Why it matters
This meta-analysis demonstrates that tibolone significantly reduces lipoprotein (a), an established cardiovascular risk factor, but simultaneously lowers cardioprotective ApoA-I in postmenopausal women.
Limits
The abstract does not report the total number of participants, doses used, control group details, or statistical heterogeneity (I-squared). Only English-language manuscripts were included, and clinical cardiovascular event outcomes were not evaluated.
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