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CLINICAL STUDY

Weight cycling and high-density lipoprotein cholesterol in women: evidence of an adverse effect

A report from the NHLBI-sponsored WISE study

^a Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
^b the Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
^c the Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
^d the Division of Cardiology, Allegheny General Hospital, MCP-Hahnemann School of Medicine, Pittsburgh, Pennsylvania, USA
^e the University of Florida, Division of Cardiovascular Medicine, Gainesville, Florida, USA
^f the Division of Cardiology, Department of Medicine, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA

Manuscript received December 3, 1999; revised manuscript received April 13, 2000, accepted June 16, 2000.

Reprint requests and correspondence: Marian B. Olson, c/o WISE Coordinating Center, University of Pittsburgh, 127 Parran Hall, Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, Pennsylvania 15261
olson{at}edc.gsph.pitt.edu

OBJECTIVES

We undertook an analysis of weight cycling, coronary risk factors and angiographic coronary artery disease (CAD) in women.

BACKGROUND

The effect of weight cycling on cardiovascular mortality and morbidity is controversial, and the impact of weight cycling on cardiovascular risk factors is unclear.

METHODS

This is a cross-sectional population study of 485 women with coronary risk factors undergoing coronary angiography for evaluation of suspected myocardial ischemia enrolled in the Women’s Ischemia Syndrome Evaluation (WISE). Reported lifetime weight cycling—defined as voluntary weight loss of at least 10 lbs at least 3 times—coronary risk factors including core laboratory determined blood lipoproteins and CAD, as determined by a core angiographic laboratory, are the main outcome measures.

RESULTS

Overall, 27% of women reported weight cycling—19% cycled 10 to 19 lbs, 6% cycled 20 to 49 lbs, and 2% cycled 50+ lbs. Reported weight cycling was associated with 7% lower high-density lipoprotein cholesterol (HDL-C) levels in women (p = 0.01). The HDL-C effect was directly related to the amount of weight cycled with women who lost 50 lbs/cycle having HDL-C levels 27% lower than noncyclers (p = 0.0025). This finding was independent of other HDL-C modulators, including estrogen status, physical activity level, alcohol intake, body mass index, diabetes, beta-blocker use, cigarette smoking and race. Weight cycling was not associated with an increased prevalence of CAD in this population.

CONCLUSIONS

Weight cycling is associated with lower HDL-C in women of a magnitude that is known to be associated with an increased risk of cardiac events as demonstrated in prior clinical trials.

Abbreviations and Acronyms   BMI = body mass index   CAD = coronary artery disease   HDL-C = high-density lipoprotein cholesterol   HRT = hormone replacement therapy   NHLBI = National Heart, Lung and Blood Institute   PEPI-Q = Postmenopausal Estrogen/Progesterone Intervention Activity Questionnaire   TC = total plasma cholesterol   WISE = Women’s Ischemia Syndrome Evaluation

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