Tibolone has a number of beneficial effects on the cardiovascular system. It increases fibrinolysis without significantly altering coagulation parameters. It Stimulates cardiac output, blood fl ow and vessel relaxation, and has no adverse effects on glucose/insulin metabolism. Clinical studies in healthy postmenopausal women and those with hypertension have revealed no adverse effects on blood pressure, whereas there is preliminary evidence of anti-ischaemic effects in women with angina. Finally, it has beneficial effects on serum triglyceride and lipoprotein(a) levels, although levels of high-density lipoprotein cholesterol are also reduced. Thus, the evidence points toward an overall beneficial effect of tibolone on cardiovascular risk. (C) 2001 The European Society of Cardiology.