Few studies have evaluated the effects of weight loss, diet, and exercise on subclinical atherosclerotic progression in healthy women using common carotid artery intima-media thickness (CIMT). The Estrogen in the Prevention of Atherosclerosis Trial (EPAT) was a 2-year randomized, double-blind, placebo-controlled trial that showed less progression of CIMT with unopposed 17β-estradiol in postmenopausal women without cardiovascular disease (CVD). We investigated the correlation between lifestyle modification and CIMT in 159 of 222 women randomized in EPAT. Data were obtained on weight, body mass index, physical activity, dietary intake, and CIMT. Women were excluded if they were diabetic or had less than two on-trial measurements of CIMT or any lifestyle factor. Summary measures for the change in each factor were adjusted for age, use of estrogen or lipid-lowering medications, and changes in total dietary energy. Increased dietary starch was associated with increased annual rate of CIMT progression (p = .005) whereas increases in dietary fat, saturated fat, and monounsaturated fat were associated with reduced CIMT progression (p < .05). Increases in individual fatty acids myristic acid (14:0), palmitic acid (16:0), palmitoleic acid (16:1), and oleic acid (18:1) were also predictors of decreased rate of CIMT progression (p < .05). Other lifestyle factors were not significantly associated with rate of CIMT progression. Past findings showed that higher intake of saturated and monounsaturated fats is associated with less progression of atherosclerosis in postmenopausal women with preexisting CVD, whereas starch is associated with more progression. Our results extend these findings to women with subclinical disease. We hypothesize that the protective effect of saturated and monounsaturated fatty acids is mediated by the generation of low-density lipoprotein particles that are resistant to oxidative modification.
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