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Exercise and diet key during midlife for women to avoid heart disease, diabetes

Modifying diet and increasing exercise during midlife can help women ward off heart disease and diabetes, Stanford-led study finds.

Women in midlife transitioning to menopause may be able to lower their risk of developing heart disease and diabetes by exercising more or eating a lower calorie diet, according to a Stanford-led study.

This is particularly important, researchers say, because as women enter the midlife period referred to as the menopausal transition, or perimenopause, they have a 1-in-3 chance of developing something called metabolic syndrome, a cluster of symptoms that put them at greater risk of heart disease, strokes and diabetes. The idea is to get rid of risk factor symptoms early on, said Jennifer Lee, MD, PhD, senior author of the study published recently in the Journal of Clinical Endocrinology & Metabolism.

To better understand what's happening to a women’s body during this midlife period, I asked Lee, a physician/researcher at both Stanford and the Palo Alto Veterans Affairs Health Care System, to define the two little known terms used to explain the study: “menopausal transition” and “metabolic syndrome."

She told me, "The menopausal transition is up to a 10-year process that occurs prior to menopause. It is under-recognized and often misunderstood. The main marker is irregular periods which is correlated with metabolic and hormonal changes."

These metabolic and hormonal changes may be at the crux of the concurrent increase in metabolic syndrome during these midlife years, she said, but it's not yet clear. The exact cause of metabolic syndrome is not known but genetic factors, too much body fat, and lack of exercise can add to its development. Patients are diagnosed with the syndrome based on measurements of their levels of abdominal fat, cholesterol, blood pressure and blood glucose, Lee said.

To conduct their study, researchers examined data collected from the Study of Women’s Health Across the Nation, or SWAN, a 22-year-old study that has been tracking the physical, biological and psychological health of 3,302 women from a variety of racial and ethnic backgrounds. The study is being conducted at seven research centers around the country and is paid for by the National Institutes of Health.

"What's rare is that the SWAN study has collected sex hormone measurements annually," Lee said. The study also collected medical histories, tracked menstrual cycles and surveyed participants' lifestyle behaviors. "The genius of the SWAN study is that it provides the data necessary to better understand this under-recognized critical stage in women's life."

Researchers then looked at two outcomes. First, they diagnosed the women who developed metabolic syndrome during midlife, and then they examined those with the syndrome who actually recovered from it over a five-year period.

"We evaluated people who had it at the start of the study and followed them over the years to see if they recovered," Lee said. "Women who were more physically active were more likely to recover. Those women who had metabolic syndrome had lower activity levels and poorer diets."

The study not only suggests that healthy lifestyle changes during midlife may prevent heart disease and diabetes from occurring later in life, results also indicate that it maybe beneficial for doctors to routinely test for metabolic syndrome during the menopausal transition, Lee said.

"We often focus research on risk factors for heart disease in older women because they have the highest risks," Lee said. "But by discovering in this study that modifiable factors like physical activity and a lower calorie diet are more common in midlife women who recover from metabolic syndrome, this indicates we could design preventive strategies for women earlier in their lives."

Photo by Arisa Chattasa

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