title: Sex hormones and lipoprotein(a) concentration.
abstract: BACKGROUND
  increased level of lipoprotein(a) (Lp(a)) constitutes an emerging, independent risk factor for coronary artery disease. Recently, it has been recommended to lower increased (> 50 mg/dl) Lp(a) concentration. Most lipid lowering agents - except niacin - have little or no effect whereas sex hormones significantly reduce Lp(a) level. The effect of sex hormones on Lp(a) level is related to the setting, the drug, the dose and the way of administration. Androgen esters, oral estrogens, alone or in combination with progestogens, and tibolone constantly decrease Lp(a) level, especially in postmenopausal women.
  
  
  METHODS
  this paper reviews the pathophysiology, structure and metabolism of Lp(a). Clinical studies evaluating, in various settings, the effect of exogenous administration of androgens, estrogens - alone or in combination with progestogens - selective receptor estrogen modulators (SERMs), aromatase inhibitors (AIs) and tibolone on Lp(a) level are analyzed.
  
  
  CONCLUSIONS
  the results obtained for SERMs are conflicting whereas AIs do not seem to reduce Lp(a) concentration. The effect of hormonal therapy on lipids is complex, depending on drugs and way of administration. Moreover, both androgens and estrogen could determine, in specific settings, severe adverse effects. These drugs are not currently recommended either for treatment of dyslipidemias with increased Lp(a) level or for the prevention of cardiovascular disease.
authors.affiliation: Antonio Cardarelli Hospital, Cardiology Unit, 38, Via Bernardo Cavallino, 80128 Naples, Italy. giovanni.gaeta@tin.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gaeta
authors.forename: Simona
authors.initials: S
authors.lastname: Lanero
authors.forename: Silvia
authors.initials: S
authors.lastname: Barra
authors.forename: Nunzia
authors.initials: N
authors.lastname: Silvestri
authors.forename: Vittoria
authors.initials: V
authors.lastname: Cuomo
authors.forename: Crescenzo
authors.initials: C
authors.lastname: Materazzi
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Vitagliano
mesh_terms: D000728:Androgens / Q000378:metabolism / Q000494:pharmacology* / Q000627:therapeutic use; D000818:Animals; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000517:prevention & control; D050171:Dyslipidemias / Q000188:drug therapy; D004967:Estrogens / Q000378:metabolism / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D017270:Lipoprotein(a) / Q000097:blood / Q000378:metabolism*; D020845:Selective Estrogen Receptor Modulators / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000728:Androgens; D018931:Antineoplastic Agents, Hormonal; D004967:Estrogens; D017270:Lipoprotein(a); D020845:Selective Estrogen Receptor Modulators