Effects of a Combination of Phytoestrogens on Risk Factors for Cardiovascular Diseases in Climacteric Women: A Randomized, Placebocontrolled Trial

Article ID: e260422204074 Pages: 9

  • * (Excluding Mailing and Handling)

Abstract

Background & Aims: The incidence of cardiovascular disease in climacteric women has increased, becoming the main cause of death in mature women. The use of phytoestrogens, isoflavones, and lignans derived from soy and flaxseed can be natural alternative treatments for this phase of life. This study investigates the utility of isoflavones and lignans derived from soy and flaxseed as natural alternatives to pharmaceuticals to alleviate the symptoms of menopause.

Methods: A clinical, prospective, randomized, blind, placebo-controlled trial was performed. Forty- eight women aged 40 to 65 years were divided into two groups, Phytoestrogen (PHY), which received a cereal bar containing isoflavones and lignans for 90 days, and Placebo (PLA), which received expanded rice flake bar. The sociodemographic, clinical, anthropometric data, blood pressure (BP) measurements, and biochemical and hormonal tests were performed.

Results: Forty-three women were included in this study (PHY=21 and PLA=22). There was a significant reduction in diastolic BP in the PHY group after the intervention (p<0.001). The frequency of BP fluctuations in the PHY group significantly decreased to 23.8% after the intervention period (p=0.027), with no significant differences for the other indicators studied.

Conclusion: The combination of phytoestrogens showed a trend in reducing the blood pressure of climacteric women. However, no significant changes in cardiovascular risk factors were observed.

Keywords: Menopause, estrogen deficiency, lipid metabolic disorder, isoflavones, lignans, cereal bar

[1]
Sanchez-Barajas, M.; Ibarra-Reynoso, L.D.R.; Ayala-Garcia, M.A.; Malacara, J.M. Flow mediated vasodilation compared with carotid intima media thickness in the evaluation of early cardiovascular damage in menopausal women and the influence of biological and psychosocial factors. BMC Womens Health, 2018, 18(1), 153.
[http://dx.doi.org/10.1186/s12905-018-0648-3] [PMID: 30236100]
[2]
Ko, S.H.; Kim, H.S. Menopause-associated lipid metabolic disorders and foods beneficial for postmenopausal women. Nutrients, 2020, 12(1), 202.
[http://dx.doi.org/10.3390/nu12010202] [PMID: 31941004]
[3]
Husain, D.; Khanna, K.; Puri, S.; Haghighizadeh, M. Supplementation of soy isoflavones improved sex hormones, blood pressure, and postmenopausal symptoms. J. Am. Coll. Nutr., 2015, 34(1), 42-48.
[http://dx.doi.org/10.1080/07315724.2013.875434] [PMID: 25648211]
[4]
Yamamoto, H.H.; Araujo, J.M.; Lima, S.M. Síndrome metabólica após a menopausa: Prevalência da hipertensão arterial em mulheres com sobrepeso e obesidade. Arq. Med. Hosp. Fac. Cienc. Med. Santa Casa São Paulo., 2017, 62(1), 1-6.
[5]
Guerra Júnior, G.E.S.; Caldeira, A.P.; Oliveira, F.P.S.L.; Brito, M.F.S.F.; Gerra, K.D.O.S.; D’Angelis, C.E.M.; dos Santos, L.A.N.; Pinho, L.; Rocha, J.S.B.; Popoff, D.A.V. Quality of life in climacteric women assisted by primary health care. PLoS One, 2019, 14(2)e0211617
[http://dx.doi.org/10.1371/journal.pone.0211617] [PMID: 30811409]
[6]
El Khoudary, S.R.; Thurston, R.C. Cardiovascular implications of the menopause transition: Endogenous sex hormones and vasomotor symptoms. Obstet. Gynecol. Clin. North Am., 2018, 45(4), 641-661.
[http://dx.doi.org/10.1016/j.ogc.2018.07.006] [PMID: 30401548]
[7]
Engelbert, A.K.; Soukup, S.T.; Roth, A.; Hoffmann, N.; Graf, D.; Watzl, B.; Kulling, S.E.; Bub, A. Isoflavone supplementation in postmenopausal women does not affect leukocyte LDL receptor and scavenger receptor CD36 expression: A double-blind, randomized, placebo-controlled trial. Mol. Nutr. Food Res., 2016, 60(9), 2008-2019.
[http://dx.doi.org/10.1002/mnfr.201600019] [PMID: 27004411]
[8]
Chen, L.R.; Ko, N.Y.; Chen, K.H. Isoflavone supplements for menopausal women: A systematic review. Nutrients, 2019, 11(11), 2649.
[http://dx.doi.org/10.3390/nu11112649] [PMID: 31689947]
[9]
Sjögren, L.L.; Mørch, L.S.; Løkkegaard, E. Hormone replacement therapy and the risk of endometrial cancer: A systematic review. Maturitas, 2016, 91, 25-35.
[http://dx.doi.org/10.1016/j.maturitas.2016.05.013] [PMID: 27451318]
[10]
Luís, Â.; Domingues, F.; Pereira, L. Effects of red clover on perimenopausal and postmenopausal women’s blood lipid profile: A meta-analysis. Climacteric, 2018, 21(5), 446-453.
[http://dx.doi.org/10.1080/13697137.2018.1501673] [PMID: 30269660]
[11]
De Franciscis, P.; Colacurci, N.; Riemma, G.; Conte, A.; Pittana, E.; Guida, M.; Schiattarella, A. A nutraceutical approach to menopausal complaints. Medicina (Kaunas), 2019, 55(9), 544.
[http://dx.doi.org/10.3390/medicina55090544] [PMID: 31466381]
[12]
Palma, F.; Fontanesi, F.; Neri, I.; Xholli, A.; Facchinetti, F.; Cagnacci, A. Blood pressure and cardiovascular risk factors in women treated for climacteric symptoms with acupuncture, phytoestrogens, or hormones. Menopause, 2020, 27(9), 1060-1065.
[http://dx.doi.org/10.1097/GME.0000000000001626] [PMID: 32852460]
[13]
Basu, P.; Maier, C. Phytoestrogens and breast cancer: In vitro anticancer activities of isoflavones, lignans, coumestans, stilbenes and their analogs and derivatives. Biomed. Pharmacother., 2018, 107(1), 1648-1666.
[http://dx.doi.org/10.1016/j.biopha.2018.08.100] [PMID: 30257383]
[14]
Kirichenko, T.V.; Myasoedova, V.A.; Orekhova, V.A.; Ravani, A.L.; Nikitina, N.A.; Grechko, A.V.; Sobenin, I.A.; Orekhov, A.N. Phytoestrogen-rich natural preparation for treatment of climacteric syndrome and atherosclerosis prevention in perimenopausal women. Phytother. Res., 2017, 31(8), 1209-1214.
[http://dx.doi.org/10.1002/ptr.5841] [PMID: 28593720]
[15]
Gencel, V.B.; Benjamin, M.M.; Bahou, S.N.; Khalil, R.A. Vascular effects of phytoestrogens and alternative menopausal hormone therapy in cardiovascular disease. Mini Rev. Med. Chem., 2012, 12(2), 149-174.
[http://dx.doi.org/10.2174/138955712798995020] [PMID: 22070687]
[16]
Guan, L.; Yeung, S.Y.; Huang, Y.; Chen, Z.Y. Both soybean and kudzu phytoestrogens modify favorably the blood lipoprotein profile in ovariectomized and castrated hamsters. J. Agric. Food Chem., 2006, 54(13), 4907-4912.
[http://dx.doi.org/10.1021/jf060709a] [PMID: 16787047]
[17]
Lu, L.W.; Chen, N.W.; Nayeem, F.; Nagamani, M.; Anderson, K.E. Soy isoflavones interact with calcium and contribute to blood pressure homeostasis in women: A randomized, double-blind, placebo controlled trial. Eur. J. Nutr., 2020, 59(6), 2369-2381.
[http://dx.doi.org/10.1007/s00394-019-02085-3] [PMID: 31535213]
[18]
Glisic, M.; Kastrati, N.; Gonzalez-Jaramillo, V.; Bramer, W.M.; Ahmadizar, F.; Chowdhury, R.; Danser, A.J.; Roks, A.J.; Voortman, T.; Franco, O.H.; Muka, T. Associations between phytoestrogens, glucose homeostasis, and risk of diabetes in women: A systematic review and meta-analysis. Adv. Nutr., 2018, 9(6), 726-740.
[http://dx.doi.org/10.1093/advances/nmy048] [PMID: 30462180]
[19]
Yamagata, K. Soy isoflavones inhibit endothelial cell dysfunction and prevent cardiovascular disease. J. Cardiovasc. Pharmacol., 2019, 74(3), 201-209.
[http://dx.doi.org/10.1097/FJC.0000000000000708] [PMID: 31356541]
[20]
Schulz, K.F.; Altman, D.G.; Moher, D. CONSORT 2010 Statement: Updated guidelines for reporting parallel group randomised trials. BMC Med., 2010, 8(18), 18.
[http://dx.doi.org/10.1186/1741-7015-8-18] [PMID: 20334633]
[21]
Phenol-Explorer. Database on polyphenol content in foods., 2019. Available from: http://phenol-explorer.eu/
[22]
Bhaqwat, S.; Haytowitz, D.B. Database for the isoflavone content of selected foods-USDA. U.S Department of Agriculture. 2015. Available from: https://data.nal.usda.gov/dataset/usda-database-isoflavone-content-selected-foods-release-21-november-201Accessed on June 20, 2019.
[23]
Perna, S.; Peroni, G.; Miccono, A.; Riva, A.; Morazzoni, P.; Allegrini, P.; Preda, S.; Baldiraghi, V.; Guido, D.; Rondanelli, M. Multidimensional effects of soy isoflavone by food or supplements in menopause women: A systematic review and bibliometric analysis. Nat. Prod. Commun., 2016, 11(11), 1733-1740.
[http://dx.doi.org/10.1177/1934578X1601101127] [PMID: 30475519]
[24]
Carraro, J.C.C.; Dantas, M.I.S.; Espechit, A.C.R.; Martino, H.S.D.; Ribeiro, S.M.R. Flaxseed and human health: Reviewing benefits and adverse effects. Food Rev. Int., 2012, 28(1), 203-230.
[http://dx.doi.org/10.1080/87559129.2011.595025]
[25]
Ursoniu, S.; Sahebkar, A.; Andrica, F.; Serban, C.; Banach, M. Effects of flaxseed supplements on blood pressure: A systematic review and meta-analysis of controlled clinical trial. Clin. Nutr. ESPEN, 2016, 35(3), 615-625.
[http://dx.doi.org/10.1016/j.clnu.2015.05.012] [PMID: 26071633]
[26]
Kupperman, H.S.; Blatt, M.H.; Wiesbader, H.; Filler, W. Comparative clinical evaluation of estrogenic preparations by the menopausal and amenorrheal indices. J. Clin. Endocrinol. Metab., 1953, 13(6), 688-703.
[http://dx.doi.org/10.1210/jcem-13-6-688] [PMID: 13061588]
[27]
Tao, M.; Shao, H.; Li, C.; Teng, Y. Correlation between the modified kupperman index and the menopause rating scale in chinese women. Patient Prefer. Adherence, 2013, 7(1), 223-229.
[PMID: 23569361]
[28]
Ferro-Luzi, A.; Garza, C. Haas, J. Physical status: The use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organization technical report series. Genebra 1995. Available from: https://apps.who.int/iris/handle/10665/37003 Accessed on: May 13, 2018.
[29]
World Health Organization. Obesity: preventing and managing the global. WHO Consultation On Obesity. World Health Organization technical report series. Genebra 2000. Available from: https://apps.who.int/iris/handle/10665/42330.
[30]
Casey, D.E.; Thomas, R.J.; Bhalla, V.; Commodore-Mensah, Y.; Heidenreich, P.A.; Kolte, D.; Muntner, P.; Smith, S.C.; Spertus, J.A.; Windle, J.R.; Wozniak, G.D.; Ziaeian, B. AHA/ACC clinical performance and quality measures for adults with high blood pressure: A report of the american college of cardiology/american heart association task force on performance measures. J. Am. Coll. Cardiol., 2019, 74(21), 2661-2706.
[31]
Brazilian Society of Clinical Pathology and Laboratory Medicine. Clinical Laboratory Accreditation Program. Brazilian Medical Association; Milograph: Rio de Janeiro, 2010.
[32]
Sathyapalan, T.; Aye, M.; Rigby, A.S.; Fraser, W.D.; Thatcher, N.J.; Kilpatrick, E.S.; Atkin, S.L. Soy reduces bone turnover markers in women during early menopause: A randomized controlled trial. J. Bone Miner. Res., 2017, 32(1), 157-164.
[http://dx.doi.org/10.1002/jbmr.2927] [PMID: 27465911]
[33]
Carmignani, L.O.; Pedro, A.; Costa-Paiva, L.H.; Pinto-Neto, A.M. O efeito de um suplemento alimentar à base de soja e terapia hormonal em baixa dose sobre os principais marcadores de risco cardiovascular: Ensaio clinic randomizado controlado. Rev. Bras. Ginecol. Obstet., 2014, 36(6), 251-258.
[http://dx.doi.org/10.1590/S0100-720320140004976] [PMID: 25099464]
[34]
Simbalista, R.L.; Sauerbronn, A.V.; Aldrighi, J.M.; Arêas, J.Á. Consumption of a flaxseed-rich food is not more effective than a placebo in alleviating the climacteric symptoms of postmenopausal women. J. Nutr., 2010, 140(2), 293-297.
[http://dx.doi.org/10.3945/jn.109.113886] [PMID: 20007337]
[35]
Wu, W.H.; Kang, Y.P.; Wang, N.H.; Jou, H.J.; Wang, T.A. Sesame ingestion affects sex hormones, antioxidant status, and blood lipids in postmenopausal women. J. Nutr., 2006, 136(5), 1270-1275.
[http://dx.doi.org/10.1093/jn/136.5.1270] [PMID: 16614415]
[36]
Saxena, S.; Katare, C. Evaluation of flaxseed formulation as a potential therapeutic agent in mitigation of dyslipidemia. Biomed. J., 2014, 37(6), 386-390.
[http://dx.doi.org/10.4103/2319-4170.126447] [PMID: 25163498]
[37]
Prasad, K.; Khan, A.S.; Shoker, M. Flaxseed and its components in treatment of hyperlipidemia and cardiovascular disease. Int. J. Angiol., 2020, 29(4), 216-222.
[http://dx.doi.org/10.1055/s-0040-1709129] [PMID: 33268971]
[38]
Matthews, K.A.; Crawford, S.L.; Chae, C.U.; Everson-Rose, S.A.; Sowers, M.F.; Sternfeld, B.; Sutton-Tyrrell, K. Are changes in cardiovascular disease risk factors in midlife women due to chronological aging or to the menopausal transition? J. Am. Coll. Cardiol., 2009, 54(25), 2366-2373.
[http://dx.doi.org/10.1016/j.jacc.2009.10.009] [PMID: 20082925]
[39]
Ye, Y.B.; Wang, Z.L.; Zhuo, S.Y.; Lu, W.; Liao, H.F.; Verbruggen, M.; Fang, S.; Mai, H.Y.; Chen, Y.M.; Su, Y.X. Soy germ isoflavones improve menopausal symptoms but have no effect on blood lipids in early postmenopausal Chinese women: A randomized placebo-controlled trial. Menopause, 2012, 19(7), 791-798.
[http://dx.doi.org/10.1097/gme.0b013e31823dbeda] [PMID: 22278344]
[40]
Colli, M.C.; Bracht, A.; Soares, A.A.; de Oliveira, A.L.; Bôer, C.G.; de Souza, C.G.; Peralta, R.M. Evaluation of the efficacy of flaxseed meal and flaxseed extract in reducing menopausal symptoms. J. Med. Food, 2012, 15(9), 840-845.
[http://dx.doi.org/10.1089/jmf.2011.0228] [PMID: 22925074]
[41]
Chen, F.P.; Chang, C.J.; Chao, A.S.; Huang, H.Y.; Huang, J.P.; Wu, M.H.; Tsai, C.C.; Kung, F.T.; Chang, C.W.; Tsai, Y.C. Efficacy of Femarelle for the treatment of climacteric syndrome in postmenopausal women: An open label trial. Taiwan. J. Obstet. Gynecol., 2016, 55(3), 336-340.
[http://dx.doi.org/10.1016/j.tjog.2016.04.008] [PMID: 27343311]