Coronary Artery Disease
Weight Cycling and High-density Lipoprotein
Cholesterol in Women: Evidence of an Adverse Effect
A Report from the NHLBI-sponsored WISE Study
Marian B. Olson, MS,* Sheryl F. Kelsey, PHD,* Vera Bittner, MD, FACC,† Steven E. Reis, MD, FACC,‡
Nathaniel Reichek, MD, FACC,§ Eileen M. Handberg, PHD,? C. Noel Bairey Merz, MD, FACC,¶
for the Women’s Ischemia Syndrome Evaluation (WISE) Study Group
Pittsburgh, Pennsylvania; Birmingham, Alabama; Gainesville, Florida; and Los Angeles, California
We undertook an analysis of weight cycling, coronary risk factors and angiographic coronary
artery disease (CAD) in women.
The effect of weight cycling on cardiovascular mortality and morbidity is controversial, and
the impact of weight cycling on cardiovascular risk factors is unclear.
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.
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.
(J Am Coll Cardiol 2000;36:1565–71) © 2000 by the American College of Cardiology
The effect of weight cycling (repeated weight loss and
weight gain) on cardiovascular mortality and morbidity is
controversial. Previous studies have shown that while
weight loss has a beneficial effect on cardiovascular risk
factors in obese patients, especially those with comorbidities
(1,2), weight cycling may confer an elevated risk of death
from cardiovascular disease (3–6). In 1994, the National
Task Force on the Prevention and Treatment of Obesity
concluded, “Although conclusive data on the long-term
effects of weight cycling are lacking, non-obese individuals
should attempt to maintain a stable weight” (7). Given that
40% of adult women report attempts to lose weight (8),
there is a compelling need for investigation in this area.
Investigation into biologically plausible mechanisms,
whereby weight cycling might elevate cardiovascular risk, is
limited. Studies evaluating weight loss and regain in animals
have been inconsistent (9). Previous studies performed on
obese/overweight women and men have failed to demon-
strate any adverse relationships between weight cycling and
coronary risk factors (10,11). Finally, much of the previous
work has not distinguished intentional from unintentional
weight loss (7).
We undertook an analysis of weight cycling, coronary risk
factors and angiographic coronary artery disease (CAD) in
women enrolled in the Women’s Ischemia Syndrome Eval-
uation (WISE). We hypothesized that weight cycling would
be associated with an adverse effect on coronary risk factors,
thereby potentially promoting the development of CAD.
The WISE study is a National Heart, Lung and Blood
Institute (NHLBI) sponsored four-center study that aims to
From the *Department of Epidemiology, Graduate School of Public Health,
University of Pittsburgh, Pittsburgh, Pennsylvania; the †Division of Cardiovascular
Disease, Department of Medicine, University of Alabama at Birmingham, Birming-
ham, Alabama; the ‡Cardiovascular Institute, University of Pittsburgh Medical
Center, Pittsburgh, Pennsylvania; the §Division of Cardiology, Allegheny General
Hospital, MCP-Hahnemann School of Medicine, Pittsburgh, Pennsylvania; the
?University of Florida, Division of Cardiovascular Medicine, Gainesville, Florida and
the ¶Division of Cardiology, Department of Medicine, Cedars-Sinai Research
Institute, Cedars-Sinai Medical Center, Los Angeles, California. Supported by
contracts from the National Heart, Lung and Blood Institutes, nos. N01-HV-68161,
N01-HV-68162, N01-HV-68163, N01-HV-68164; a GCRC grant MO1-RR00425
from the National Center for Research Resources and grants from the Gustavus and
Louis Pfeiffer Research Foundation, Denville, New Jersey; The Women’s Guild of
Cedars-Sinai Medical Center, Los Angeles, California; The Ladies Hospital Aid
Society of Western Pennsylvania, Pittsburgh, Pennsylvania and QMED, Laurence
Harbor, New Jersey.
Manuscript received December 3, 1999; revised manuscript received April 13,
2000, accepted June 16, 2000.
Journal of the American College of Cardiology
© 2000 by the American College of Cardiology
Published by Elsevier Science Inc.
Vol. 36, No. 5, 2000
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JACC Vol. 36, No. 5, 2000
November 1, 2000:1565–71
Olson et al.
Weight Cycling and HDL-C