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Lewis Kuller

University of Pittsburgh Schools of the Health Sciences

Women Must Develop Healthy Lifestyles Well Before Menopause to Avoid Heart Disease in Later Years

PITTSBURGH, November 13, 2000 — Women must exercise and watch their diets before menopause to prevent life-threatening coronary calcium deposits from developing after menopause, according to research presented by University of Pittsburgh researcher Lewis H. Kuller, M.D., Dr. P.H., at the 73rd Scientific Sessions of the American Heart Association in New Orleans.

These findings grew out of the Women’s Healthy Lifestyle Project, a five-year, randomized clinical trial testing the efficacy of a behavioral lifestyle intervention program of exercise and low-fat diet in preventing increases in low-density lipoprotein (LDL) cholesterol (the so-called "bad" cholesterol) and weight gain during the peri- to post-menopausal period.

"Women cannot afford to wait until middle age to begin a healthy lifestyle. They need to control poor diet, lack of exercise, obesity and high blood pressure while they are still young," said Dr. Kuller, principal investigator, and chairman of the department of epidemiology at the University of Pittsburgh’s Graduate School of Public Health. "By middle age, the damage from an unhealthy lifestyle could already be done."

Researchers found that pre-menopausal levels of LDL cholesterol as measured at the beginning of the lifestyle intervention were predictive of post-menopausal coronary artery calcium deposits as measured after the study. Also predictive of post-menopausal calcium deposits were higher pre-menopausal degrees of other cardiovascular disease risk factors such as triglyceride levels, waist circumference, body-mass index and blood pressure.

"This is the first study to use electron beam computed tomography (EBCT) to evaluate the relationship between risk factors measured pre-menopausal and the extent of coronary calcium early in menopause," said Dr. Kuller.

The study included 535 pre-menopausal women who were randomly assigned to a behavioral lifestyle intervention group, which included a low-fat, reduced-calorie diet and physical activity component, or to an assessment-only control group. At the start of the study their average age was 47. After 54 months 176 of the participants were considered to be post-menopausal, with 59 percent of them on hormone replacement therapy (HRT).

At the conclusion of the study, significant differences in coronary calcium were discovered between those women who showed high levels of risk factors at baseline, and those whose risk factors were low. The study found that women who were much heavier, with higher body mass index and larger waists, had developed coronary calcium. Their total cholesterol was 203 mg, compared with a level of 189 mg for women without coronary calcium. There were no significant differences in the extent of coronary calcium by use of HRT among post-menopausal women. Nor were there differences in coronary calcium between women in the intervention group and the controls.

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