Search
Close
Search
Advanced Search
Search Menu
AI Discovery Assistant

Extract

We read with great interest the article by Yuk et al., which provides valuable insights into the association between menopausal hormone therapy (MHT) and cardiovascular disease (CVD) risk in Korean women.1 This large-scale, population-based cohort study offers critical data on the differential effects of various MHT regimens, particularly highlighting the increased risk associated with tibolone and the potential cardioprotective role of dydrogesterone (DYD). While the study is commendable for its robust methodology and comprehensive analysis, we would like to address several points that warrant further discussion and consideration.

First, the study identifies tibolone as significantly associated with an increased risk of CVD (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.27–1.50), consistent with prior findings.2 However, the authors briefly mention potential mechanisms, such as elevated C-reactive protein levels and reduced high-density lipoprotein cholesterol, without delving into the broader implications of these findings. Tibolone's unique tissue-selective activity, which mimics estrogen, progestogen, and androgen effects, may contribute to its complex cardiovascular profile. For instance, its androgenic activity could exacerbate atherogenesis in predisposed individuals. Future studies should explore whether genetic predispositions or metabolic factors, such as insulin resistance or lipid profiles, mediate this increased risk in specific populations. Additionally, stratifying tibolone users by baseline cardiovascular risk factors could provide more actionable insights for clinicians.

Issue Section:
Letter
You do not currently have access to this article.
Download all slides