Tibolone lowers lipoprotein(a) by 7.49 mg/dL in postmenopausal women, a meta-analysis of 13 randomised trial arms (Eur J Obstet Gynecol Reprod Biol 2024)

Original title: The effect of tibolone treatment on apolipoproteins and lipoprotein (a) concentrations in postmenopausal women: A meta-analysis of randomized controlled trials

Eur J Obstet Gynecol Reprod Biol · 16 October 2023 · 6

Li C, Wei M, Mo L, Velu P, Prabahar K, Găman MA, Chen M

This meta-analysis of 12 randomised controlled trials (13 trial arms) examined the effect of tibolone, a hormone replacement therapy for postmenopausal women, on apolipoproteins and Lp(a). Tibolone reduced ApoA-I (WMD -34.96 mg/dL, 95% CI -42.44 to -27.48, P<0.001) and Lp(a) (WMD -7.49 mg/dL, 95% CI -12.17 to -2.81, P=0.002), with no significant effect on ApoA-II or ApoB. The Lp(a)-lowering effect was larger in women under 60 years (WMD -10.78 mg/dL) and with treatment of 6 months or less (WMD -15.69 mg/dL). The findings suggest tibolone could offer an incidental Lp(a)-lowering benefit in postmenopausal women, alongside its established use for menopausal symptoms.

Original abstract

Objective: Tibolone is a synthetic steroid with estrogenic, androgenic and progestogenic properties that is used as hormone replacement therapy (HRT) in postmenopausal women. Treatment with tibolone has been demonstrated to lead to changes of the lipid profile, including alterations in lipoprotein (a) and apolipoprotein levels. Hence, we conducted the present meta-analysis of randomized controlled trials (RCTs) to assess the effect of tibolone treatment on apolipoproteins and lipoprotein (a) values in postmenopausal women.

Methods: Several databases (Cochrane Library, PubMed/Medline, Scopus, and Google Scholar) were searched for English-language manuscripts published up to September 2023 that scrutinized 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. The results were reported as the weighted mean difference (WMD) with a 95% confidence interval (CI), generated using a random-effects model.

Results: Finally, 12 publications with 13 RCT arms were included in the current meta-analysis. The overall results from the random-effects model demonstrated a notable reduction in ApoA-I (n = 9 RCT arms, WMD: -34.96 mg/dL, 95 % CI: -42.44, -27.48, P < 0.001) and lipoprotein (a) (n = 12 RCT arms, WMD: -7.49 mg/dl, 95 % CI: -12.17, -2.81, P = 0.002) after tibolone administration in postmenopausal women. However, treatment with tibolone did not impact ApoA- II (n = 4 RCT arms, WMD: 1.32 mg/dL, 95 % CI: -4.39, 7.05, P = 0.64) and ApoB (n = 9 RCT arms, WMD: -2.68 mg/dL, 95 % CI: -20.98, 15.61, P = 0.77) values. In the subgroup analyses, we noticed a notable decrease in lipoprotein (a) levels when tibolone was prescribed to females aged < 60 years (WMD: -10.78 mg/dl) and when it was prescribed for ≤ 6 months (WMD: -15.69 mg/dl).

Conclusion: The present meta-analysis of RCTs highlighted that treatment with tibolone reduces lipoprotein (a) and apolipoprotein A-I levels in postmenopausal women. As the decrease in serum lipids' concentrations is associated with a decrease in the risk of cardiovascular disease (CVD), treatment with tibolone could be a suitable therapy for postmenopausal women with elevated CVD risk.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.