Healthy lifestyle important to primary prevention in postmenopausal women with normal BMI

Key takeaways:

• Postmenopausal women with normal BMI may improve CVD risk by maintaining a healthy lifestyle.
• This includes healthy diet, low alcohol intake, no smoking, physical activity and lower waist circumference.

Despite no history of CVD and normal BMI, maintaining a healthy lifestyle involving diet, low alcohol intake, no smoking and physical activity may be important for postmenopausal women in preventing a first CVD event, researchers reported.

Higher scoring on a healthy lifestyle index was associated with lower 20-year risk for a CVD event among otherwise healthy postmenopausal women with normal BMI, according to a study published in the Journal of the American Heart Association.

“Several studies have shown that a relatively high healthy lifestyle index, which reflects a high-quality diet, moderate to high physical activity, low alcohol consumption, a relatively small waist circumference, and no cigarette smoking, is associated with reduced risk of CVD,” Rita Peila, PhD, of the department of epidemiology and population health at the Albert Einstein College of Medicine, and colleagues wrote. “Although previous studies have examined the association of individual behavioral factors, such as a sedentary lifestyle, with CVD risk among women with a normal BMI, none has examined whether a combination of these factors, as reflected in a higher healthy lifestyle index, is associated with reduced risk of CVD among individuals with a normal BMI.”

To better understand CV risk among postmenopausal women with normal BMI — defined as 18.5 kg/m² to less than 25 kg/m² — and no prior CVD, Peila and colleagues created a healthy lifestyle index derived from scores for healthy diet, light alcohol consumption, no smoking, moderate or intense physical activity and waist circumference. The analysis included 40,118 participants in the Women’s Health Initiative, who were subsequently stratified into quintiles of healthy lifestyle index scores, with the lowest quintile including women with the unhealthiest lifestyle.

The primary outcome was first occurrence of CVD, defined as stroke, CHD, angina requiring hospitalization and revascularization.

During a median follow-up of 20.1 years, 3,821 first CVD cases were documented.

Compared with the lowest quintile, women in the higher quintiles of healthy lifestyle scores experienced lower risk for first CVD and its individual components:

• second quintile (HR = 0.74; 95% CI, 0.67-0.81);
• third quintile (HR = 0.66; 95% CI, 0.6-0.72);
• fourth quintile (HR = 0.57; 95% CI, 0.51-0.63); and
• fifth quintile (HR = 0.48; 95% CI, 0.43-0.54; P for trend < .001).

After completing subgroup analyses stratified by age, BMI and general health status, the researchers reported that higher healthy lifestyle index score remained significantly associated with reduced risk for first CVD event among postmenopausal women with normal BMI.

“Excessive weight has been on the rise worldwide, accounting for a higher percentage of CVD cases. This is of great importance during menopause, when weight gain and changes in body composition often occur,” the researchers wrote. “The increasing prevalence of elevated BMI has led to the recommendation to adopt a healthy lifestyle, which includes being physically active and consuming a healthy diet mainly aimed at weight loss and/or its maintenance within a normal ‘healthy’ range. While obtaining and/or maintaining a normal BMI is an important lifestyle goal, our results indicate that modifying lifestyle behaviors may be important to significantly reduce the risk of CVD even among women with normal BMI.”