Atherosclerosis at menopause slowed by diet and exercise

Thickening of artery walls accelerates as women enter menopause, but these signs of the progression of atherosclerosis can be slowed by a lower-fat diet and increased physical activity, according to a new study in the Aug. 4, 2004, issue of the Journal of the American College of Cardiology.

“The importance of this paper is that we were able to show that the successful intervention was accompanied by a measurable slowing of the progression of subclinical atherosclerosis that occurs during menopause,” said Kim Sutton-Tyrrell, DrPH, at the University of Pittsburgh. “These are the first intervention data showing that modification of these risk factors actually slows progression of disease.”

The researchers, including lead author Rachel P. Wildman, PhD, who is now at Tulane University in New Orleans, analyzed ultrasound images of carotid arteries in 353 women who were part of the Women’s Healthy Lifestyle Project. About half the women took part in a lifestyle intervention program to reduce dietary fat and boost physical activity, with a weight loss goal of five to 15 pounds, depending on their starting weights. The women in the control group received the same checkups but not the intensive group sessions and lifestyle follow-up support of the women in the intervention group.

All of the women were premenopausal when they entered the trial. Ultrasound measurements of the walls of their carotid arteries were taken twice during a four-year period. A third measurement was obtained 21/2 years later for 113 of the women. The measurements looked at thickening of the intima (innermost) and media (middle) layers of artery walls, which has been linked to atherosclerosis and cardiovascular disease risk.

Among women in the control group, thickening of the carotid artery walls progressed faster for women who went through menopause during the trial (0.008 millimeters per year for women during or after menopause compared to 0.003 millimeters per year for premenopausal women.)

When the researchers analyzed results from the 160 women who entered menopause during the trial, average artery wall thickening was slower in the lifestyle intervention group (0.004 millimeters per year in the intervention group compared to 0.008 millimeters per year in the control group.)

“Diet and exercise really work. Not only do they result in lower weight and cholesterol levels, the result is also a slowing of disease progression. This is particularly important for women undergoing the menopausal transition because this is a point at which the progression of disease seems to accelerate. The intervention prevented this acceleration of disease progression that occurs with menopause,” Dr. Sutton-Tyrrell said.

She stressed that the benefits seen during and after menopause should not diminish the importance of physical activity and healthy diet for younger women.“No, not at all. The issue is that the risk for women accelerates after menopause, so diet and exercise become even more important!” she said.

Dr. Sutton-Tyrrell noted that the study included a relatively small number of women. However, she pointed out that observing an effect in this small a population indicates the benefits of lifestyle changes are strong.

Nanette K. Wenger, MD, at the Emory University School of Medicine in Atlanta, who wrote an editorial in the journal, said this study contains an important message about the benefits of a healthy lifestyle for women during and after menopause.

“The items to be emphasized are the efficacy of diet and exercise, not only in preventing weight gain and the associated significant reductions in cholesterol and triglycerides, blood pressure and glucose levels in perimenopausal women, but now the observation of efficacy in slowing the progression of atherosclerosis, as ascertained by limitation of progression of carotid intima media thickness,” Dr. Wenger said.

Dr. Wenger wrote that pivotal questions remain about why risk factors increase in women during and after menopause; including whether the increased risk factors are linked to the physiologic changes of menopause itself or to behavior changes that coincide with menopause. She added that the underlying effects of aging and variations in different ethnic groups and other subpopulations of women need to be studied.

The American College of Cardiology, a 29,000-member nonprofit professional medical society and teaching institution, is dedicated to fostering optimal cardiovascular care and disease prevention through professional education, promotion of research, leadership in the development of standards and guidelines, and the formulation of health care policy.