Phytoestrogens and coronary microvascular function in women with suspected myocardial ischemia: a report from the Women's Ischemia Syndrome Evaluation (WISE) Study.
OBJECTIVE
Soy phytoestrogens are popular, but information on their coronary effects in patients with suspected ischemic heart disease is limited. Accordingly, we investigated the relationship between blood phytoestrogen levels and coronary reactivity in women with suspected myocardial ischemia referred for coronary angiography.


METHODS
Coronary flow velocity reserve (CFVR) and volumetric flow reserve (VFR) to adenosine (ADO) and nitroglycerin (NTG) (nonendothelial-dependent responses) and acetylcholine (ACH) (endothelial-dependent response) were assessed in 106 women from the Women's Ischemia Syndrome Evaluation (WISE). Blood phytoestrogen (daidzein and genistein) and estrogen (estradiol) levels were correlated with coronary reactivity measures.


RESULTS
Participants were mostly postmenopausal (79%), mean age 56 years, and 24% had obstructive coronary artery disease (CAD) at angiography. Genistein blood levels were negatively correlated with nonendothelial-dependent coronary flow responses. The highest genistein tertile (>6.1 ng/mL) had a CFVR of 2.1 +/- 0.5 (mean +/- SD) and VFRADO of 1.0 +/- 0.6, and both were significantly (p= 0.0001) lower compared with the other genistein tertiles combined. Similar associations were noted for CFVR(NTG) and VFR(NTG) (p = 0.03 and p = 0.01, respectively). The highest genistein tertile was associated with lower CFVR(ACH) compared with the other tertiles (p = 0.03). In multivariable modeling, blood genistein levels were significant independent predictors of coronary flow responses to ADO. There were no significant correlations between coronary reactivity variables and daidzein or endogenous estrogen.


CONCLUSIONS
In women with suspected myocardial ischemia, higher genistein blood levels are associated with impaired nonendothelial-dependent and endothelial-dependent coronary microvascular function.
Pepine
Carl J
CJ
Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida 32610-0277, USA. pepincj@medicine.ufl.edu
von Mering
Gregory O
GO
Kerensky
Richard A
RA
Johnson
B Delia
BD
McGorray
Susan P
SP
Kelsey
Sheryl F
SF
Pohost
Gerald
G
Rogers
William J
WJ
Reis
Steven E
SE
Sopko
George
G
Bairey Merz
C Noel
CN
D000109:Acetylcholine / Q000097:blood; D000241:Adenosine / Q000097:blood; D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood* / Q000000981:diagnostic imaging; D003331:Coronary Vessels / Q000503:physiopathology; D004958:Estradiol / Q000097:blood; D005260:Female; D019833:Genistein / Q000097:blood; D006801:Humans; D007529:Isoflavones / Q000097:blood; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000000981:diagnostic imaging / Q000503:physiopathology; D005996:Nitroglycerin / Q000097:blood; D048789:Phytoestrogens / Q000097:blood*; D011237:Predictive Value of Tests
D007529:Isoflavones; D048789:Phytoestrogens; D004958:Estradiol; C004742:daidzein; D019833:Genistein; D005996:Nitroglycerin; D000241:Adenosine; D000109:Acetylcholine