-
Views
-
Cite
Cite
Jin-Sung Yuk, Gwang Sil Kim, Dong-Gil Kim, Young Sup Byun, Myoung-Hwan Kim, Sang-Hee Yoon, Gwan Hee Han, Byung Gyu Kim, Response by Yuk et al. to letter regarding article, “Association of menopausal hormone therapy with risk of cardiovascular disease in Korean women”, European Journal of Endocrinology, Volume 192, Issue 3, March 2025, Pages L14–L15, https://doi.org/10.1093/ejendo/lvaf041
- Share Icon Share
Extract
We appreciate the thoughtful comments by Li et al. on our recent study, “Association of menopausal hormone therapy with risk of cardiovascular disease in Korean women”.1 Their insights highlight key areas for further exploration, and we welcome the opportunity to address their points.
Tibolone's mechanistic complexity and population-specific risks
Li et al. emphasized the need to explore genetic and metabolic factors underlying the association between tibolone and increased cardiovascular disease (CVD) risk (hazard ratio [HR], 1.38; 95% CI, 1.27-1.50).2 We acknowledge the complexity of tibolone's tissue-selective activity. While our study highlighted tibolone's tissue-selective activity (eg, androgenic effects on lipid profiles), we did not have detailed data on genetic predispositions and insulin resistance in our analysis. As noted, tibolone exhibits estrogenic, progestogenic, and androgenic effects, which may influence its cardiovascular risk profile. While we briefly discussed potential mechanisms, such as increased C-reactive protein (CRP) levels and reductions in high-density lipoprotein cholesterol (HDL-C), we agree that further investigation is needed into genetic predispositions, metabolic factors, and the role of androgens in atherogenesis. Additionally, stratified analyses based on baseline cardiovascular risk factors, such as lipid profiles and inflammatory markers, could enhance risk prediction. Future studies incorporating biomarkers (eg, CRP and LDL/HDL ratios) and genetic data (eg, estrogen receptor polymorphisms) could further refine risk stratification among tibolone users, allowing for a more precise identification of high-risk subgroups and yielding additional clinical insights.