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Impact of anti-oestrogen therapy on lipoprotein(a) in postmenopausal women: a systematic review and meta-analysis of double-blind placebo-controlled clinical studies

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Abstract

Purpose

The potential mechanisms of endocrine therapy for thrombosis remain currently unclear, and more studies are warranted for further investigation and elucidation. However, high plasma concentration of lipoprotein(a) (Lp(a)) is a recognized prothrombotic factor. The aim of our study was to systematically evaluate the effect of different anti-oestrogen therapy on plasma Lp(a) level in postmenopausal women.

Methods

A systematic literature search was conducted in multiple electronic databases to identify the randomized, double-blind, placebo-controlled clinical studies on this topic. Effect size for changes in Lp(a) was expressed as mean difference (MD) and 95% confidence intervals (CI).

Results

Data were pooled from 10 clinical trials comprising 24 treatment arms, which included 2049 women (1128 women in the active-treated arms and 921 women in the control arms). Meta-analysis of data suggested that anti-oestrogen therapy in women significantly reduced Lp(a) [MD = −5.92% (95%CI: −9.05%,−2.8%)].

Conclusions

This observation is of both clinical and pathophysiological relevance, also in view that the identification of molecular determinants and cellular pathways implicated in Lp(a) synthesis and metabolism is still of concern as a critical issue in lipidology and CV prevention.

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Data availability

Data supporting study’s findings are available from the Corresponding Author.

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Author notes

  1. These authors contributed equally: Federica Fogacci, Claudio Borghi

Authors and Affiliations

  1. Hypertension and Cardiovascular Risk Research Group, Medical and Surgical Sciences Department, Sant’Orsola-Malpighi University Hospital, 40138, Bologna, Italy

    Federica Fogacci, Claudio Borghi & Arrigo F. G. Cicero

  2. IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy

    Claudio Borghi & Arrigo F. G. Cicero

  3. Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy

    Sergio Davinelli & Giovanni Scapagnini

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Contributions

Conceptualization, F.F. and A.F.G.C.; Methodology, F.F. and A.F.G.C.; Formal analysis, F.F.; Investigation, F.F., C.B., S.D., G.S., and A.F.G.C.; Data curation, F.F., C.B., and A.F.G.C.; Writing—original draft preparation, F.F. and A.F.G.C.; Writing—review and editing, C.B., S.D., and G.S.; Visualization, F.F.; Supervision, A.F.G.C.; Project administration, A.F.G.C. All authors have read and agreed to the published version of the paper.

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Correspondence to Arrigo F. G. Cicero.

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Fogacci, F., Borghi, C., Davinelli, S. et al. Impact of anti-oestrogen therapy on lipoprotein(a) in postmenopausal women: a systematic review and meta-analysis of double-blind placebo-controlled clinical studies. Endocrine 80, 292–302 (2023). https://doi.org/10.1007/s12020-022-03287-2

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