The pendulum swings from fear to understanding

The diet and exercise regimen used in the study was designed to reduce fat and cholesterol, prevent weight gain, and increase physical activity.

End points were progression of intimamedia thickness in the common carotid artery, internal carotid artery, and bulb segments.

The control group had significantly greater increases in intima-media thickness in women who became postmenopausal compared with those who remained premenopausal.

For women who became perimenopausal or postmenopausal during this 4-year study, diet and exercise slowed the progression of intima-media thickness by a 47% average reduction (P< 0.05), but had no effect on carotid segments in the women who remained premenopausal.

No benefit in intima media thickness was seen in women who remained premenopausal during the trial. Nevertheless, there are many well-documented benefits of healthy diet and exercise in premenopausal women.

Also of note, hormone therapy initiated after baseline measurements did not alter the results.

The message for patients, especially perimenopausal patients is that there is no time like the present to start a healthy lifestyle.

No downside

We’ve learned from the Nurse’s Health Study,²an observational study, that women who eat a healthy diet, do not smoke, and who exercise can reduce their risk of coronary heart disease by 57%.

We learned from the randomized controlled trial by the Diabetes Prevention Program Research Group³ that diet and exercise in high-risk women for 3 years can reduce incidence of new diabetes by 58%.

Now, in this trial, we learn that diet and exercise can reduce the progression of atherosclerosis in perimenopausal women by nearly 50%.

Since there is little, if any, downside to healthy living, why wait?

Dr. Utian has served as an advisor/consultant for Eli Lilly, Pfizer, and Novartis. He has received research funding from Amylin, 3m, Barr, Berlex, BMS, Eli Lilly, Forest, Galen, Glaxo Smith Kline, Neurocrine Biosciences, Novartis, Novo Nordisk, Organon, Pharmacia, P&G, Pfizer, Roche, Sepracor, Solvay, Wyeth, and Yamanouchi.

Dr. Ettinger has served as an advisor for Berlex, Duramed-Barr, Glaxo Smith Kline, and P&G.

REFERENCES

1. Kuller LH, Simkin-Silverman LR, Wing RR, Meilahn EN, Ives DG. Women’s Healthy Lifestyle Project: a randomized clinical trial: results at 54 months. Circulation. 2001;103:32-37.

2. Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000;343:16-22.

3. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403.