**Author details**

262 Lipoproteins – Role in Health and Diseases

Tibolone is another drug used in hormonal replacement therapy having estrogenic, progestogenic, and androgenic effects. Long-term treatment does appear to decrease anxiety, improve semantic memory and overall quality of life; however, one study reported that those in treatment did score worse on attention task compared to women not on treatment (Table 1) [56,57]. Tibolone appears to be the most beneficial with respect to reducing total cholesterol, triglyercide, HDL and ApoA-1 levels compared to raloxifene and estradiol (Table 1) [47,58-60]. This suggests that hormone replacement therapy with medications such as tibolone in post-menopausal women are beneficial to cognitive health

Cetrorelix an antagonist of hypothalamic luteinizing hormone-releasing hormone (LHRH), is used in treatment of prostate carcinoma, benign prostatic hyperplasia, and ovarian cancer to reduce gonadotrophins and sex steroids [61]. In mice, a study suggests that it is anxiolytic, anti-depressive and able to correct beta-amyloid 25-35 associated memory consolidation impairments (Table 1) [61]. Injection of cetrorelix into *ApoE* deficient mice (*ApoE-/-*) mice suggests that the associated suppression of testosterone leads to increased atherosclerosis despite lower cholesterol levels in the male mice [62]. In female *ApoE-/-* mice, the reduction in testosterone also leads to reduction in estradiol, insulin and HDL levels without effects on atherosclerosis [62]. In a pilot study conducted in men, treatment with cetrorelix resulted in increased ApoA-1, HDL, insulin and leptin consistently (Table 1) [63]. Therefore, when this drug is used within a chemotherapy treatment regiment it is important to carefully monitor lipid levels. Additional studies are needed to examine if *ApoE* genotype

has any effect on response and potential long-term cognitive side effects of this drug.

how to properly maintain lipid levels during chemotherapy.

chemotherapy cognitive impairments.

chemotherapy treatment.

**5. Conclusion** 

1. Determine if an *ApoE* genotype can help assess what is most treatment useful including

2. Find out lipid levels, track and maintain determined treatment to reduce risk of post-

3. Examine *ApoE* genotype before selecting pharmacotherapy options pre or post-

Overall of the studies SERMs/aromatase inhibitors raloxifene or exemestane may be better alternatives to tamoxifen or letrozole treatment in terms of effects on cognitive deficits and overall health risk in women treated with chemotherapy. In addition, *ApoE* genotype and cholesterol levels need to be taken into account when examining efficacy of these drugs and

**3.7. Tibolone** 

and lipid profiles.

**3.8. Cetrorelix** 

**4. Recommendations** 

Summer F. Acevedo\*

Department of Physiology, Pharmacology, and Toxicology, Psychology Program, Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico
