Comments Regarding Cardiovascular Prevention not Applicable

Letters to the Editor Special Aspects of Cholesterol Metabolism in Women by Prof. Dr. med. Ioanna Gouni-Berthold and Prof. Dr. med. Ulrich Laufs in issue 12/2024

With regard to the review article by Gouni-Berthold and Laufs, please allow me the following comments:

Polycystic ovary syndrome is a heterogeneous and complex endocrinologic clinical entity with several phenotypes that differ clearly from one another as far as the cardiovascular risk is concerned. Undoubtedly, obesity and the associated insulin resistance have a crucial role in this. In the later reproductive years, the development/characteristic of the syndrome reduces (2), so that the cardiovascular events and associated mortality with age and in the menopause in these patients are comparable with that of healthy women (3).

As regards postmenopausal estrogen substitution, I think that the role of these hormones should not only be considered and emphasized as modulators of the lipid metabolism but also regarding the vasomotor activity and atherogenesis.

Stratification of hormone replacement by age and time since the menopause shows unequivocally that younger women who receive hormone replacement at the start of their menopause show a reduction in the risk for myocardial infarction as well as a reduction in overall mortality (4), which means that the statement in the article does not apply in the context of cardiovascular prevention. The effect of adding a gestagen on lipids depends on the type of gestagen—for example, gestagens with a partial androgen/IC effect have negative effects.

DOI: 10.3238/arztebl.m2024.0181

Dr. med. Athanasios Alexopoulos

Internist/Endokrinologe

Zentrum für Hormon- und Stoffwechselerkrankungen

MVZ endokrinologikum München

Conflict of interest statement

The author declares that no conflict of interest exists.

References

1. Gouni-Berthold I, Laufs U: Special aspects of cholesterol metabolism in women. Dtsch Arztebl Int 2024; 121: 401–6.

2. Carmina E, Campagna AM, Lobo RA: A 20-year follow-up of young women with polycystic ovary syndrome. Obstet Gynecol 2012; 119: 263–9.

3. Ramezani Tehrani F, Amiri M, Behboudi-Gandevani S, et al.: Cardiovascular events among reproductive and menopausal age women with polycystic ovary syndrome: a systematic review amd meta-analysis. Gynecol Endocrinol 2020; 36: 12–23.

4. Flores VA, Pal L, Manson JAE: Hormone therapy in menopause: concepts, contoversies and approach to treatment. Endocr Rev 2021; 42: 720–52.