In menopausal women physical activity and taking dietary supplements may protect against coronary artery disease
- Correspondence to: Professor Robyn Gallagher, Faculty of Health, University of Technology, Sydney Broadway, NSW 2007, Australia;
Implications for practice and research
Physical activity and taking dietary supplements may have a protective effect for coronary artery disease in menopausal women.
Screening for coronary artery disease risk factors in menopausal women should include whether women have exercised in the past 2 weeks or taken a dietary supplement.
Worldwide, coronary artery disease is a leading cause of death in women. Multiple factors which increase the risk of coronary artery disease have been previously identified, with the profiles of men and women differing. Women's risk for coronary artery disease increases significantly at menopause when prevention of coronary artery disease becomes an important health goal. Prevention not only includes reducing risk factors such as hypertension, but also addressing protective factors such as dietary supplementation and physical activity. Few studies have investigated these protective factors in women, particularly at the time of menopause. Tsai and colleagues compared the risk profiles of Taiwanese middle-aged women who have coronary artery disease with healthy controls.
Tsai and colleagues’ study was based on a sample of women suspected of coronary artery disease who had undergone coronary artery angiography and had been diagnosed as having coronary artery disease (>50% stenosis, n=31) compared with healthy controls (no stenosis, n=34). Risk factor profiles were established prior to angiography for metabolic and biomarker factors using standardised blood tests and anthropometry, and self-report survey for lifestyle factors including standardised dietary supplementation and physical activity questionnaires. Of the 122 participants eligible prior to angiography, 91 agreed to participate and the characteristics of these women did not differ from the women who refused to participate. Following angiography, 26 women did not fit the disease or healthy control classification and were ineligible to participate. Multiple logistic regression analysis was used to determine independent risk factors for coronary artery disease.
Women in the study were aged mean 56.2 years and 63% were postmenopausal. There were few differences between the two groups; women with coronary artery disease were more likely to have diabetes mellitus, higher diastolic blood pressure and less likely to use dietary supplements or to be physically active. The logistic regression analyses identified that there were only two independent predictors of coronary artery disease; taking dietary supplements and being physically active resulted in 72% and 98% reductions in the odds of having coronary artery disease.
The results of the study are important because they identify two key modifiable behaviours that have a pronounced impact on the development of coronary artery disease in women. This study adds to a mounting body of evidence for the protective effects of physical activity1 ,2 and demonstrates that even a small amount of structured activity can markedly reduce the risk of developing coronary artery disease. However, the effects of physical activity are dose dependent and participants in this study were generally quite active, taking part in structured exercise more than three times/week. The case for the protective effects of dietary supplements is less certain in the literature. In part, this is because of the availability of a range of supplements, including vitamins, antioxidants, calcium, Ω-3 fatty acids and homocysteine.3 Neither the type of supplement nor other potentially important predictors such as education level or general health awareness were included in the multivariate analyses. It is also unclear whether the results of this study could be generalised to other women, particularly those living in Western countries, as the sample was relatively healthy, exercising regularly with a body mass index only slightly above ideal (mean 26.6 kg/m2). Given the worldwide growth in obesity identified by the WHO, where rates of obesity have doubled over the past two decades,4 this is an important difference. Nevertheless, from the data collected two items, recent exercise and dietary supplements were different in women who had coronary artery disease from those who did not. Physical activities and dietary supplements could be readily incorporated into screening menopausal women at risk of coronary artery disease and advocated when promoting positive health practices.