Epidemiology
Combined hormone therapy lowers Lp(a) by 5.1 mg/dL in postmenopausal women, meta-analysis of 27 trials finds (Diabetol Metab Syndr 2025)
Original title: The effect of medroxyprogesterone acetate plus conjugated equine estrogens on lipoprotein(a) and apolipoprotein concentrations in postmenopausal women: a systematic review and meta-analysis of randomized controlled trials
This systematic review and meta-analysis searched multiple databases through April 2025 for randomised controlled trials testing medroxyprogesterone acetate plus conjugated equine estrogens (MPA/CEE) on apolipoprotein and Lp(a) concentrations in postmenopausal women, aiming to resolve inconsistent prior findings. Twenty-seven RCTs with 37 study arms were included in the random-effects meta-analysis. MPA/CEE administration was associated with a significant increase in Apolipoprotein A1 (weighted mean difference 12.42 mg/dL, 95% CI 9.31-15.52, P < 0.001), and significant decreases in Apolipoprotein B (WMD -6.84 mg/dL, 95% CI -8.28 to -5.39, P < 0.001) and Lp(a) (WMD -5.12 mg/dL, 95% CI -6.58 to -3.65, P < 0.001). The authors conclude MPA/CEE has a favourable effect on this atherogenic lipoprotein profile in postmenopausal women, potentially correlating with reduced cardiovascular risk, though hormone therapy's own cardiovascular risk-benefit profile involves other considerations beyond lipids.
Original abstract
Objective: The influence of medroxyprogesterone acetate plus conjugated equine estrogens (MPA/CEE) on apolipoproteins and lipoprotein(a) levels has been vastly studied with inconsistent results. These inconsistencies could be attributed to several factors, such as the characteristics of the included participants and dosage and duration of intervention, among others. This study was conducted to determine the impact of MPA/CEE on the lipoprotein(a) and apolipoprotein concentrations in the postmenopausal women through a systematic review and meta-analysis of randomized controlled trials (RCTs).
Methods: A comprehensive search was conducted across multiple databases for relevant RCTs up to April 2025, and a random-effects model was used to conduct a meta-analysis, with results presented as the weighted mean difference (WMD) along with a 95% confidence interval (CI). Subgroup and sensitivity analyses were further conducted to find potential sources of heterogeneity.
Results: The current meta-analysis included 27 RCTs with 37 study arms. The study results revealed an increase in Apolipoprotein A1 (WMD: 12.42 mg/dL, 95%CI: 9.31, 15.52, P < 0.001), as well as a decline in Apolipoprotein B (WMD: -6.84 mg/dL, 95%CI: -8.28, -5.39, P < 0.001) and lipoprotein(a) (WMD: -5.12 mg/dL, 95%CI: -6.58, -3.65, P < 0.001) concentrations following MPA/CEE administration in postmenopausal women.
Conclusions: This meta-analysis indicates that MPA/CEE has a beneficial impact in the levels of atherogenic lipoproteins, which be correlated with a reduction in cardiovascular disease risk.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.