Currie_edit.qxp 17/7/08 09:36 Page 14
Disease Risk Management
Figure 4: Incidence of Cardiovascular Disease—Relation to
health and should be a major consideration in menopausal women. Blood
Menopause Status (the Framingham Study)
pressure is usually checked as part of a menopause assessment, and
subsequently as part of the review for women who take hormone
7
6.5
replacement therapy. Increasing exercise and weight loss can help to reduce
6
blood pressure, but often drug therapy is needed. Since cholesterol levels
5 increase with the changes that occur at menopause, checking the cholesterol
4.0
4
3.6 3.6
level should also be considered as part of the menopause assessment. It has
3
been shown that a 10% reduction in LDL cholesterol can lead to a reduction
c
e (per 1,000 women) 2.2
in risk for CVD of up to 20%.
14
2
2.0
c
iden
In
1
0.6 0.6
Specific Cholesterol-lowering Dietary Methods
0
Some interest has been shown in specific dietary methods of reducing
<40 40–44 45–49 50–54
Age (years) cholesterol level, with a variety of foods containing active ingredients that have
been shown to have LDL-cholesterol-lowering properties. Active ingredients
Pre-menopausal Post-menopausal
include plant sterols/stanols (added to foods such as margarine, milk products,
n=2,873. and yogurts), beta-glucan (a soluble fibre found in oats), and soy protein (found
Source: Kannel WB, et al., Ann Intern Med, 1976;85:447–52.
in soy-based products). In the case of beta-glucan, the ingredient in oats-based
cereals, the evidence supports cholesterol lowering in the range of 2–5% when
Figure 5: Cholesterol-lowering Effects of Diet and Drug Therapy
3–5g beta-glucan is consumed daily. Eating 25g per day of soya protein as part
0
of a low-fat diet has also been shown to lower cholesterol by 3–5%.
Healthy diet Healthy diet Healthy diet
However, one of the most effective ways to lower LDL cholesterol through
Plant sterol-
dietary changes is by the inclusion of plant sterols or stanols. Plant sterols and
-10
enriched foods
stanols lower LDL cholesterol levels by blocking the absorption of cholesterol
Statin
from food during digestion, and also by blocking the re-absorption of
treatment cholesterol from the liver. Taking 2–2.5g of plant sterols per day is thought
-20
to lower LDL cholesterol by an average of 10% within two to three weeks.
c
holesterol-lowering
When combined with a healthy diet and lifestyle, LDL cholesterol can be
further reduced by 5%.
15
Plant sterols and stanols have no effect on HDL
% LDL-
-30
cholesterol or triglycerides. For some women, drugs such as statins may be
Plant sterol-
required and plant sterols and stanols can be used in conjunction with lipid-
enriched foods
lowering medications. The 10% cholesterol lowering of plant sterols is
additive to that of a healthy cholesterol-lowering diet and cholesterol-
-40
lowering medications such as statins and fibrates (see Figure 5).
15,16
LDL = low-density lipoprotein.
Conclusion
increasing exercise can in fact help to reduce symptoms as well as benefiting CVD is by far the biggest cause of death in women after the menopause and
long-term health. Women should be encouraged to maintain a healthy yet there is still a low level of awareness among both women and health
weight by means of a healthy diet (with five portions of fruit and vegetables professionals. Because the changes that occur at menopause lead to an
per day, using wholegrain, high-fibre foods, cutting down on saturated fats, increased risk for CVD, menopause discussion should include assessment of
increasing mono- and polyunsaturated fats and cutting down on salt) and risk factors for long-term health problems, in particular osteoporosis and CVD;
by increasing exercise, aiming for 30 minutes of moderate exercise (brisk consideration should also be given to the measurement of cholesterol level as
walking provides the same benefit as vigorous exercise) at least five days per routine, along with blood pressure and body mass index. When indicated,
week. Stopping smoking can improve not only heart health but also bone emphasis on diet and lifestyle advice should be first-line management. ■
1. American Heart Association, Women and cardiovascular disease and management, Obstet Gynecol Surv, 2006;61(9):608–13. consultation, WHO Technical Report Series 916, 2003.
facts, American Heart Association, 2007. 8. Williams CM, Lipid metabolism in women, Proc Nutr Soc, 14. National Cholesterol Education Program, Executive summary of
2. World Health Organisation, 2004. Available at: 2004;63(1):153–60. the third report of the national Cholesterol Education Program
www.who3.who.int/whosis/mort/table1_process.cfm 9. Rosano GMC, et al., Menopause and cardiovascular disease: the (NCEP) expert panel on detection, evaluation and treatment of
3. Schenck-Gustaffson K, Diagnosis of cardiovascular disease in evidence, Climacteric, 2007;10(1):19–24. high blood cholesterol in adults (adult treatment panel 111),
women, Menopause Int, 2007;13:19–22. 10. Kannel WB, McGhee DL, Diabetes and cardiovascular disease. The J Am Med Assoc, 2001;285:2486–97.
4. Bello N, Mosca L, Epidemiology of coronary heart disease in Framingham study, J Am Med Assoc, 1979;241:2035–8. 15. Katan MB, et al., Stresa Workshop Participants. Efficacy and safety
women, Prog Cardiovasc Dis, 2004;46(4):287–95. 11. Kannel WB, Levy D, Menopause, hormones and cardiovascular of plant stanols and sterols in the management of blood
5. Jackson G, Gender differences in cardiovascular disease vulnerability in women, Arch Intern Med, 2004;164:479–81. cholesterol levels (Review), Mayo Clinic Proc, 2003;78:965–78.
prevention, Menopause Int, 2008;14:13–17. 12. Wenger NK, Coronary heart disease: the female heart is 16. Edwards JE, Moore RA, Statins in hypercholesterolaemia: a dose
6. Taylor Nelson Sofres for Unilever, Survey of attitudes to vulnerable, Prog Cardiovasc Dis, 2003;46:199–229. specific meta-analysis of lipid changes in randomized, double
menopause and cholesterol, December 2007. 13. World Health Organisation (WHO), Diet, nutrition and the blind trials, BMC Fam Pract, 2003;4:18.
7. Schnatz PF, Schnatz JD, Dyslipidemia in menopause: mechanisms prevention of chronic diseases. Report of a joint WHO/FAO expert
14 US CARDIOLOGY
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