Lipid predictors of coronary heart disease and tibolone users

Tibolone reduces plasma levels of total cholesterol by approximately 5%, triglycerides by approximately 25% and lipoprotein(a) by 20-30%, with little effect on the levels of low-density lipoproteins. In contrast to these theoretical beneficial effects. there is a 20-30% fall in levels of high-density lipoproteins (HDL). The failure of recent placebo-controlled clinical trials of hormone replacement therapy to show a cardiovascular benefit with elevated HDL levels raises the possibility that hormone replacement therapy-induced plasma lipid changes may not accurately predict clinical events. Advances in our understanding of lipoprotein metabolism. especially resulting from identification of new receptors, challenge the conventional belief that reducing HDL levels will cause cardiovascular disease. (C) 2001 The European Society of Cardiology.