phytoestrogens and Hypercholesterolemia

Hypercholesterolemia is a predominant risk factor for atherosclerosis and associated coronary and cerebrovascular diseases. Control of cholesterol levels through therapeutic drugs, notably statins, have significantly reduced the risk for developing atherosclerosis and associated cardiovascular diseases. However, adverse effects associated with therapeutic drugs warrant to find other alternative approaches for managing hypercholesterolemia, especially for those with borderline cholesterol levels. Food supplements have increasingly become attractive alternatives to prevent or treat hypercholesterolemia and reduce the risk for cardiovascular diseases. This review summarized current patents on food supplements with claims of hypocholesterolemic effects. They can be mainly divided into four categories based on the active ingredients in the supplements: 1) plant sterols or stanols; 2) fiber or polysaccharides; 3) microorganism-derived; and 4) soy protein and phytoestrogens. The efficacy, mechanisms of action and potential side effects are reviewed for each of the four categories. The hypocholesterolemic effects of plant sterols, fiber, Monascus products and soy protein preparations have been consistently demonstrated in clinical trails whereas the efficacy of some probiotic bacteria and phytoestrogens-containing supplements remains to be established. Accumulative clinical data show that plant sterols, fiber, soy protein and phytoestrogen are generally considered safe and cause no obvious side effects. However, additional clinical studies are required to establish the safety profiles of certain probiotic bacteria as food supplements.

Topics: Anticholesteremic Agents; Atherosclerosis; Bile Acids and Salts; Dietary Fiber; Humans; Hypercholesterolemia; Lipoproteins, HDL; Lipoproteins, LDL; Monascus; Phytoestrogens; Phytosterols; Polysaccharides; Probiotics; Sitosterols; Soybean Proteins

Epidemiological studies have demonstrated that elevated levels of plasma total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) are the major risk factors for coronary heart disease (CHD), whereas high concentrations of plasma high-density lipoprotein cholesterol (HDL-C) and a low ratio of TC to HDL-C are protective against CHD. A relationship between plasma TC and the risk of CHD is well established at concentrations above 240 mg/dL. In addition to the use of three main classes of cholesterol-lowering medications, including HMG-CoA reductase inhibitors, anion-exchange resins, and fibrates, a nutritionally balanced diet that reduces saturated fat and cholesterol intake has traditionally been the first goal of dietary therapy in lowering plasma TC. In recent years, nutraceuticals and functional foods have attracted much interest as possible alternative therapies for lowering plasma TC, especially for hypercholesterolemia patients, whose blood cholesterol level is marginally high (200-240 mg/dL) but not high enough to warrant the prescription of cholesterol-lowering medications. This review summarizes the findings of recent studies on the production, application, efficacy, and mechanisms of popular cholesterol-lowering nutraceuticals and functional foods.

Topics: Animals; Anticholesteremic Agents; Catechin; Cultured Milk Products; Dietary Fiber; Dietary Supplements; Fagopyrum; Flavonoids; Garlic; Humans; Hypercholesterolemia; Naphthalenes; Oryza; Phenols; Phytoestrogens; Phytosterols; Polyphenols; Tea

There is increasing evidence that dietary supplementation, such as L-arginine, anti-oxidant vitamins, soy phytoestrogens, flavonoids and omega-3 fatty acids exert vascular protective benefits particularly in terms of restoring endothelial function in cardiovascular disease states. The endothelium has been a major focus over the past 20 years as being a primary site at which dysfunction occurs in association with, and contributing to, vascular pathologies. Such states include mild compromise of the cardiovascular system as observed in smokers, hypercholesterolemics and hypertensives, through to end-point heart failure. This review will focus on the experimental and clinical evidence examining the effect of nutriceuticals on vascular function, in particular endothelium-derived factors, and argues that there is a role for nutriceuticals in the clinical management of the cardiovascular compromised individual.

Topics: Animals; Antioxidants; Arginine; Arteriosclerosis; Cardiovascular Diseases; Dietary Supplements; Endothelium, Vascular; Fatty Acids, Omega-3; Flavonoids; Humans; Hypercholesterolemia; Isoflavones; Phytoestrogens; Plant Preparations; Vitamins

This article is designed to help nursing professionals advise patients about the role of soy in the prevention and treatment of heart disease, breast cancer, and prostate cancer. Soy protein lowers total cholesterol, low-density lipoprotein cholesterol, and triglycerides in humans and inhibits atherosclerosis in animals. In cell culture studies and animal research, the soy isoflavone genistein offers protection from breast cancer and prostate cancer because it prevents cancer initiation, slows promotion, and impedes cancer progression. This article synthesizes the current research concerning soy phytoestrogens and the prevention and treatment of heart disease, breast cancer, and prostate cancer. Nursing professionals may use this information when counseling patients.

Topics: Animals; Arteriosclerosis; Breast Neoplasms; Estrogens, Non-Steroidal; Female; Glycine max; Humans; Hypercholesterolemia; Isoflavones; Male; Patient Education as Topic; Phytoestrogens; Plant Preparations; Prostatic Neoplasms; Risk Factors; Soybean Proteins

Daidzein (one of the major isoflavones) can be metabolized to equol in certain individuals. The effects of isoflavones alone and equol status on lipid profiles are still controversial. To evaluate the 6-mo effects of daidzein on cardiovascular risk factors in hypercholesterolemic individuals and the interactions of these effects with equol status and estrogen receptor (ESR) genotypes, we conducted a randomized, double-blind, placebo-controlled trial consisting of 210 hypercholesterolemic adults (40-65 y old). The participants were randomly assigned (177 completed) to consume placebo, 40 mg daidzein (DAI40), or 80 mg daidzein (DAI80) daily for 6 mo. Daidzein decreased serum triglycerides (TGs) by 0.15 ± 0.62 mmol/L (mean ± SD) and 0.24 ± 0.61 mmol/L and decreased serum uric acid by 23 ± 47 μmol/L and 29 ± 44 μmol/L in the DAI40 and DAI80 groups, respectively. These reductions in the DAI40 and DAI80 groups were greater than those in the placebo group (P < 0.05). Other blood lipids, glucose, insulin, or glycated hemoglobin did not significantly change after daidzein treatment. No dose-dependent effects of daidzein were found. The reduction of TGs was influenced by the ESR genotype, with a greater effect observed in participants with the GA genotype compared with those with the GG genotype of ESR-β RsaI. These effects were not influenced by equol status. Six-month supplementation of daidzein significantly decreased TGs and uric acid. ESR-β RsaI genotype, not equol status, influenced daidzein's effects on TGs. Daidzein consumption may be effective to improve cardiovascular risk factors, especially in adults with the GA genotype of ESR-β RsaI. This trial was registered at the Chinese clinical trial registry as ChiCTR-TRC-10001048.

Topics: Adult; Aged; Asian People; Cardiovascular Diseases; Dietary Supplements; Double-Blind Method; Energy Intake; Estrogen Receptor beta; Female; Genotype; Humans; Hypercholesterolemia; Isoflavones; Male; Middle Aged; Phytoestrogens; Risk Factors; Triglycerides; Uric Acid

We hypothesized that a dietary combination of soy with either a probiotic (yoghurt) or a prebiotic (resistant starch) would result in enhanced lipid-lowering effects compared with a control soy diet, possibly via improvements in isoflavone bioavailability.. Mildly hypercholesterolaemic subjects (men and post-menopausal women) older than 45 years were recruited via the local media. Thirty-six subjects commenced the study; five withdrew.. Soy+probiotic significantly decreased total cholesterol (4.7+/-2.0%; P=0.038) and soy+prebiotic significantly decreased total and low-density lipoprotein cholesterol (5.5+/-1.6%; P=0.003 and 7.3+/-2.2%; P=0.005, respectively). The bioavailabilities of daidzein, genistein or equol were not affected by probiotic or prebiotic consumption or associated with lipid changes.. Dietary combination of soy with either a probiotic or a prebiotic resulted in significant lipid lowering, not related to isoflavone bioavailability.

Topics: Aged; Bread; Cholesterol; Cholesterol, HDL; Cholesterol, LDL; Cross-Over Studies; Diet; Dietary Carbohydrates; Female; Genistein; Humans; Hypercholesterolemia; Isoflavones; Male; Middle Aged; Phytoestrogens; Probiotics; Soy Foods; Starch; Triglycerides; Triticum; Yogurt

Postmenopausal women are at an increased risk of developing coronary artery disease (CAD). This increase is due primarily to elevated cholesterol concentrations accompanying the loss of endogenous estrogen secretion. Recently, the consumption of soy foods has been shown to reduce serum cholesterol concentrations. Phytoestrogens (PE) have been proposed as the responsible agents of the hypocholesterolemic effect of soy foods. However, few studies have investigated the effect of PE supplementation on serum lipoproteins. The purpose of the present study is to investigate the effects of PE supplementation (150 mg) on serum lipids and lipoproteins in moderately hypercholesterolemic, elderly, postmenopausal women. Thirty-six subjects were randomized into two groups and received either a 150-mg PE supplement/d (n = 20) or a placebo (n = 16). Serum samples obtained at baseline and 2 months were analyzed for total triacylglycerol, total cholesterol, and high density lipoprotein cholesterol using standard Lipid Research Clinic procedures. In addition, total triacylglycerol and cholesterol were measured after 6 months of treatment. The t test and ANOVA were employed to compare the two groups. The results (mean +/- SEM) indicated no significant differences in total triacylglycerol (1.3 +/- 0.2 vs. 1.2 +/- 0.2 mmol/liter), total cholesterol (6.4 +/- 0.4 vs. 6.5 +/- 0.2 mmol/liter), or high density lipoprotein cholesterol (1.0 +/- 0.1 vs. 1.0 +/- 0.1 mmol/liter) between the placebo and the PE groups, respectively, after 2 months of treatment. Moreover, total triacylglycerol and cholesterol remained unchanged after 6 months. Our findings suggest that PE supplementation with 150 mg/d over a 6-month period does not significantly alter serum lipoproteins in postmenopausal women and, therefore, may not effectively reduce the risk of CAD in this population.

Topics: Aged; Cholesterol; Cholesterol, HDL; Dietary Supplements; Estrogens, Non-Steroidal; Female; Humans; Hypercholesterolemia; Isoflavones; Phytoestrogens; Plant Preparations; Postmenopause; Soybean Proteins; Triglycerides

This study sought to determine effects of high- and low-isoflavone soy protein foods on acute-phase proteins and proinflammatory cytokines and whether isoflavone phytoestrogens might act as estrogens, which enhance the immune response. Forty-one hypercholesterolemic men and postmenopausal women underwent three 1-month diets consisting of a low-fat dairy food control phase and high- and low-isoflavone soy food test phases (50 g/d and 52g/d soy protein, respectively, and 73 mg/d and 10 mg/d isoflavone, respectively). Diets were low in saturated fat (<5% of energy) and cholesterol (<50 mg/d). Fasting blood analytes and blood pressure were measured at the start and end of each phase. For the entire group of subjects, no treatment differences were observed for acute-phase proteins or proinflammatory cytokines. However, a significant interaction was noted between diet and sex. Assessing the results of men and women separately, women showed significantly higher interleukin-6 (IL-6) values after the high-isoflavone soy diet (P =.013) compared to control values. For women, the difference between the high- and low-isoflavone IL-6 values was significant using the unadjusted data (P =.048) but not after adjustment. No significant effects were seen for men or women in C-reactive protein (CRP), serum amyloid A (SAA), or tumor necrosis factor-alpha (TNF-alpha). Thus, high levels of isoflavone intake appear to increase serum concentrations of IL-6 in women. This finding may indicate an estrogenic effect of soy isoflavones in enhancing the immune response and provide a possible explanation through enhanced immune surveillance for lower incidence of certain cancers in soy-eating parts of the world.

Topics: Administration, Oral; Apolipoproteins; Biomarkers; C-Reactive Protein; Cholesterol, Dietary; Cytokines; Diet; Dietary Fats; Dose-Response Relationship, Drug; Estrogens, Non-Steroidal; Female; Glycine max; Humans; Hypercholesterolemia; Inflammation; Interleukin-6; Isoflavones; Male; Middle Aged; Phytoestrogens; Plant Preparations; Serum Amyloid A Protein; Sex Factors; Tumor Necrosis Factor-alpha

Topics: Animals; Cholesterol, Dietary; Disease Models, Animal; Female; Genistein; Hypercholesterolemia; Male; Myocardial Infarction; Phytoestrogens; Rabbits; Risk Factors

Topics: Aged; Animals; Cardiovascular Diseases; Diet; Dose-Response Relationship, Drug; Female; Humans; Hypercholesterolemia; Isoflavones; Male; Middle Aged; Netherlands; Phytoestrogens; Phytotherapy; Treatment Failure

Phytoestrogens have been suggested to lower cardiovascular disease risk, but existing research focused on non-Western high intake levels and on risk factors. We investigated whether habitual low phytoestrogen intake is associated with manifest cardiovascular disease risk.. Between 1993 and 1997, 16,165 women 49 to 70 years old and free from cardiovascular disease were enrolled in the Dutch Prospect-EPIC cohort (European Prospective study Into Cancer and nutrition) and followed up for a median period of 75 months. At enrollment, women filled in questionnaires on chronic disease risk factors and nutrition. Intake of phytoestrogens was estimated using the food frequency questionnaire covering regular dietary intake of 178 food items in the year before enrollment. Cox regression analysis was used to estimate hazard ratios of cardiovascular disease for quartiles of phytoestrogen intake adjusted for age at intake, body mass index, smoking, physical activity, hypertension, hypercholesterolemia, use of hormone replacement therapy, menopausal status, and intake of total energy, total fiber, vegetables, fruit, and alcohol. In total, 372 women experienced a coronary event (CHD) (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9], 410 to 414, 427.5) and 147 women a cerebrovascular event (CVD) (ICD-9, 430 to 438) during follow-up. Overall, neither isoflavones nor lignans were associated with decreased cardiovascular disease risk. When stratifying for ever versus never smokers, CHD risk decreased with increasing lignan intake for ever smokers.. Our results do not support the presence of a protective effect of higher intake of phytoestrogens in low doses on cardiovascular disease risk, although a small risk reduction with higher lignan intake cannot be excluded for smokers.

Topics: Aged; Alcohol Drinking; Body Mass Index; Cardiovascular Diseases; Cohort Studies; Coronary Disease; Dietary Fiber; Energy Intake; Feeding Behavior; Female; Follow-Up Studies; Fruit; Hormone Replacement Therapy; Humans; Hypercholesterolemia; Hypertension; Isoflavones; Lignans; Menopause; Middle Aged; Netherlands; Nutrition Surveys; Phytoestrogens; Proportional Hazards Models; Prospective Studies; Risk; Smoking; Stroke; Surveys and Questionnaires; Vegetables