EFFECTS OF DIET AND EXERCISE IN MEN AND POSTMENOPAUSAL WOMEN WITH LOW-LEVELS OF HDL CHOLESTEROL AND HIGH-LEVELS OF LDL CHOLESTEROL

Background Guidelines established by the National Cholesterol Educatio n Program (NCEP) promote exercise and weight loss for the treatment of abnormal lipoprotein levels. Little is known, however, about the effe cts of exercise or the NCEP diet, which is moderately low in fat and c holesterol, in persons with lipoprotein levels that place them at high risk for coronary heart disease. Methods We studied plasma lipoprotei n levels in 180 postmenopausal women, 45 through 64 years of age, and 197 men, 30 through 64 years of age, who had low high-density lipoprot ein (HDL) cholesterol levels (less than or equal to 59 mg per decilite r in women and less than or equal to 44 mg per deciliter in men) and m oderately elevated levels of low-density lipoprotein (LDL) cholesterol (>125 mg per deciliter but <210 mg per deciliter in women and >125 mg per deciliter but <190 mg per deciliter in men). The subjects were ra ndomly assigned to aerobic exercise, the NCEP Step 2 diet, or diet plu s exercise, or to a control group, which received no intervention. Res ults Dietary intake of fat and cholesterol decreased during the one-ye ar study (P<0.001), as did body weight, in women and men in either the diet group or the diet-plus-exercise group, as compared with the cont rols (P<0.001) and the exercise group (P<0.05), in which dietary intak e and body weight were unchanged. Changes in HDL cholesterol and trigl yceride levels and the ratio of total to HDL cholesterol did not diffe r significantly among the treatment groups, for subjects of either sex . The serum level of LDL cholesterol was significantly reduced among w omen (a decrease of 14.5 +/- 22.2 mg per deciliter) and men (a decreas e of 20.0 +/- 17.3 mg per deciliter) in the diet-plus-exercise group, as compared with the control group (women had a decrease of 2.5 +/- 16 .6 mg per deciliter, P<0.05; men had a decrease of 4.6 +/- 21.1 mg per deciliter, P<0.001). The reduction in LDL cholesterol in men in the d iet-plus-exercise group was also significant as compared with that amo ng the men in the exercise group (3.6 +/- 18.8 mg per deciliter, P<0.0 01). In contrast, changes in LDL cholesterol levels were not significa nt among the women (a decrease of 7.3 +/- 18.9 mg per deciliter) or th e men (10.8 +/- 18.8 mg per deciliter) in the diet group, as compared with the controls. Conclusions The NCEP Step 2 diet failed to lower LD L cholesterol levels in men or women with highrisk lipoprotein levels who did not engage in aerobic exercise. This finding highlights the im portance of physical activity in the treatment of elevated LDL cholest erol levels. (N Engl J Med 1998;339:12-20.) (C) 1998, Massachusetts Me dical Society.