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Isoflavone intake in persons at high risk of cardiovascular events: implications for vascular endothelial function and the carotid atherosclerotic burden^1,2,3

¹ From the Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China (Y-HC, K-KL, K-HY, H-TC, C-PL, and H-FT); the Department of Medicine, Tung Wah Hospital, Hong Kong, China (S-WL); the Department of Clinical Biochemistry Unit, Queen Mary Hospital, Hong Kong (ST); and the Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN (X-OS)

Background: Epidemiologic studies have suggested that a high phytoestrogen intake is inversely associated with cardiovascular disease risk factors and the incidence of cardiovascular events. However, the relation between the intake of isoflavone, a major component of phytoestrogen, and vascular endothelial function and the atherosclerotic burden remains unclear.

Objective: We aimed to investigate the effects of various dietary soy isoflavone intakes on brachial artery flow-mediated dilation and mean maximum carotid intima–media thickness.

Design: We studied 126 consecutive patients ( ± SD age: 66.5 ± 11.1 y; 69% male) at high risk of cardiovascular events (94% had documented coronary artery disease or stroke; 44% had diabetes). A validated food-frequency questionnaire was used to estimate their dietary intake after they achieved stable dietary patterns for 3 mo.

Results: The median intakes of isoflavone and soy protein were 5.5 (range: 2.2–13.3) mg/d and 1.2 (range: 0.4–2.8) g/d, respectively. Persons in the 4th quartile of daily isoflavone intake had significantly (P < 0.05) greater flow-mediated dilation—but not mean maximum carotid intima–media thickness—than did those in the lower quartiles. After adjustment for potential confounders, a higher isoflavone intake in the 4th than in the 1st quartile (>13.3 mg/d), but not a higher intake of soy protein, predicted an absolute 2.71% increase in flow-mediated dilation (relative increase: 103%; P = 0.02) and a 0.17-mm decrease in mean maximum carotid intima–media thickness (relative decrease: 14.5%; P = 0.04).

Conclusion: In persons at high risk of cardiovascular events, a greater isoflavone intake is associated with better vascular endothelial function and lower carotid atherosclerotic burden.

Key Words: Isoflavone • flow-mediated dilation • carotid intima–media thickness