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J Am Coll Cardiol, 2000; 35:1403-1410
© 2000 by the American College of Cardiology Foundation
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REVIEW ARTICLE

Phytoestrogens and cardiovascular health

Lynette Wroblewski Lissin, MDa and John P. Cooke, MD, PhD, FACCa

a Stanford University Medical Center, Stanford, California, USA

Manuscript received March 8, 1999; revised manuscript received November 24, 1999, accepted January 13, 2000.

Reprint requests and correspondence: John P. Cooke, Division of Cardiovascular Medicine, 300 Pasteur Drive, Stanford, California 94305-5406
John.Cooke{at}stanford.edu

Coronary artery disease is the leading overall cause of mortality for women and increases dramatically after menopause. Estrogen has many beneficial cardiovascular actions although concerns have been raised about its effects on the progression of breast and uterine neoplasms and its tendency to increase coagulability. Selective estrogen agonists may be superior to conventional estrogens. A dietary source of a partial estrogen agonist is the plant-based group of phytoestrogens, which include isoflavones, lignans and coumestans. Phytoestrogens have a similar structure to estradiol and have weak affinity for the estrogen receptor. Epidemiologic data indicate that women ingesting high amounts of phytoestrogens, particularly as isoflavones in soy products, have less cardiovascular disease, breast and uterine cancer and menopausal symptoms than those eating Western diets. Preclinical and clinical studies have found that isoflavones have lipid-lowering effects as well as the ability to inhibit low-density lipoprotein oxidation. They have been shown to normalize vascular reactivity in estrogen-deprived primates. Furthermore, phytoestrogens have antineoplastic effects with inhibition of cellular proliferation as well as angiogenesis, properties that could be protective against cancer development. Finally, menopausal symptoms and bone density may be favorably influenced by phytoestrogens. In summary, phytoestrogens, in the form of dietary isoflavones, represent a new area to explore in pursuit of nutritional approaches to cardiovascular protection.

Abbreviations and Acronyms
  CAD = coronary artery disease
  CVD = cardiovascular disease
  HDL = high density lipoprotein
  HRT = hormone replacement therapy
  ICAM-1 = intercellular adhesion molecule-1
  LDL = low-density lipoprotein
  VCAM-1 = vascular cell adhesion molecule-1
  VLDL = very low density lipoprotein




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