title: Lipoprotein(a) in postmenopausal women: assessment of cardiovascular risk and therapeutic options.
abstract: BACKGROUND
  Lipoprotein(a) [Lp(a)], a low-density lipoprotein (LDL)-like particle, has been independently associated with increased cardiovascular disease (CVD) risk in various populations, such as postmenopausal women. The purpose of this narrative review is to present current data on the role of Lp(a) in augmenting CVD risk in postmenopausal women and focus on the available therapeutic strategies.
  
  
  METHODS
  PubMed was searched for English language publications until November 2015 under the following terms: "therapy" OR "treatment" AND ["lipoprotein (a)" OR "Lp(a)"] AND ("postmenopausal women" OR "menopausal women" OR "menopause").
  
  
  RESULTS
  Only hormone replacement therapy (mainly oral estrogens) and tibolone have been specifically studied in postmenopausal women and can reduce Lp(a) concentrations by up to 44%, although evidence indicating a concomitant reduction in CVD risk associated with Lp(a) is lacking. As alternative treatments for women who cannot, or will not, take hormonal therapies, niacin and the upcoming proprotein convertase subtilisin / kexin type 9 (PCSK-9) inhibitors are effective in reducing Lp(a) concentrations by up to 30%. Statins have minimal or no effect on Lp(a). However, data for these and other promising Lp(a)-lowering therapies including mipomersen, lomitapide, cholesterol-ester-transfer protein inhibitors and eprotirome are derived from studies in the general, mainly high CVD risk, population, and include only subpopulations of postmenopausal women.
  
  
  CONCLUSIONS
  Past, present and emerging therapies can reduce Lp(a) concentrations to a varying extent. Overall, it remains to be proven whether the aforementioned reductions in Lp(a) by these therapeutic options are translated into CVD risk reduction in postmenopausal women.
authors.affiliation: Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Anagnostis
authors.affiliation: Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Karras
authors.affiliation: Second Department of Obstetrics and Gynecology, National and Capodestrian University of Athens, Athens, Greece.
authors.forename: Irene
authors.initials: I
authors.lastname: Lambrinoudaki
authors.affiliation: National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
authors.forename: John C
authors.initials: JC
authors.lastname: Stevenson
authors.affiliation: Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Dimitrios G
authors.initials: DG
authors.lastname: Goulis
mesh_terms: D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000378:metabolism*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D017270:Lipoprotein(a) / Q000378:metabolism*; D008875:Middle Aged; D009525:Niacin / Q000627:therapeutic use; D017698:Postmenopause / Q000378:metabolism*; D012307:Risk Factors
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017270:Lipoprotein(a); D009525:Niacin
keywords: Lipoprotein(a); Menopause; cardiovascular risk; postmenopausal women