Phytoestrogens as cardioprotective agents.

Epidemiologic studies have shown that women with a higher dietary intake of phytoestrogens, plant-derived compounds with partial estrogen agonist properties, have a lower incidence of cardiovascular disease and breast and uterine cancer than women with a lower dietary intake of these substances. The most-studied category of phytoestrogens is the isoflavones found in soybeans, chick peas, and other legumes. Genistein and daidzein are the 2 major forms of isoflavones and have demonstrated lipid-lowering properties, especially in hypercholesterolemic subjects. The mechanism for the hypocholesterolemic effects is unclear, but may involve altered hepatic metabolism, antioxidant properties, tyrosine kinase inhibition, and improved vascular reactivity. Other phytoestrogens, including coumestans and lignans, have shown unfavorable results with regard to their role in the prevention of coronary artery disease. Food and food supplements containing phytoestrogens are often advocated as an alternative to hormone replacement therapy (HRT) in women with contraindications to the use of conventional estrogen replacement or those wanting a natural alternative. In light of the recent trial results with HRT (estrogen plus progesterone), it would be prudent not to recommend phytoestrogens as cardioprotective substances until adequate safety and efficacy studies are completed.