Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
Department of Ophthalmology, University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia.
Menopause. 2020 Sep;27(9):1081-1092. doi: 10.1097/GME.0000000000001566.
Phytoestrogens are becoming popular constituents of human diets and are increasingly used by postmenopausal women.
Our study aims to determine the effects of phytoestrogen supplementation on intermediate cardiovascular disease (CVD) risk factors in postmenopausal women.
Five electronic databases (Medline, EMBASE, Web of Science, Cochrane CENTRAL, Google Scholar) were systematically searched to identify eligible studies, that is, randomized controlled trials (RCTs) that assessed the association of phytoestrogen supplementation with CVD risk factors (serum lipids, homocysteine, fibrinogen, markers of inflammation, oxidative stress and endothelial function, carotid intima-media thickness [CIMT]) in postmenopausal women. Data were extracted by two independent reviewers using a predefined data collection form.
In total, 56 RCTs were identified, including 4,039 individual postmenopausal women. There was substantial heterogeneity in quality across studies. Twenty-six (46%) RCTs showed poor quality and there was an indication of publication bias presence for some of the biomarkers. Results are reported in pooled mean difference (95% CI) of changes. Use of phytoestrogens was associated with a decrease in serum total cholesterol (-0.27 mmol/L [-0.41 to -0.13]), low-density lipoprotein (-0.25 mmol/L [-0.37 to -0.13]), triglycerides (-0.20 mmol/L [-0.28 to -0.11]), and apolipoprotein B (-0.13 g/L [-0.23 to -0.03]) and with an increase in serum apolipoprotein A-1 (0.04 g/L [0.02-0.07]. Also, phytoestrogen supplementation was associated with a decrease in serum intercellular adhesion molecule 1 (-18.86 ng/mL [-30.06 to -7.65]) and E-selectin (-2.32 ng/mL [-4.05 to -0.59]). There was no association observed between phytoestrogen supplementation and inflammatory markers, fibrinogen, homocysteine, or other endothelial function markers. In contrast, use of phytoestrogens was associated with an increase in CIMT (9.34 μm [95% CI, 0.39-18.29]). Effect estimates of phytoestrogen supplementation on oxidative stress could not be pooled.
Phytoestrogen supplementation seems to modestly improve the CVD risk profile of postmenopausal women by influencing blood lipids and parameters of endothelial function. In women with an increased risk of atherosclerosis, although modest, a harmful effect on CIMT progression may be present. Because of limited quality and the heterogeneous nature of the current evidence, additional rigorous studies are needed to explore the role of phytoestrogens in menopausal cardiovascular health. : Video Summary: http://links.lww.com/MENO/A593.
植物雌激素正成为人类饮食中的流行成分，越来越多地被绝经后妇女使用。
我们的研究旨在确定植物雌激素补充对绝经后妇女中间心血管疾病（CVD）风险因素的影响。
系统地检索了五个电子数据库（Medline、EMBASE、Web of Science、Cochrane CENTRAL、Google Scholar），以确定合格的研究，即评估植物雌激素补充与 CVD 风险因素（血清脂质、同型半胱氨酸、纤维蛋白原、炎症标志物、氧化应激和内皮功能、颈动脉内膜中层厚度 [CIMT]）之间关联的随机对照试验（RCT）在绝经后妇女。数据由两名独立审查员使用预定义的数据收集表提取。
共确定了 56 项 RCT，包括 4039 名单独的绝经后妇女。研究之间的质量存在很大差异。26 项（46%）RCT 质量较差，一些生物标志物存在发表偏倚的迹象。结果以变化的汇总平均差异（95%CI）报告。植物雌激素的使用与血清总胆固醇（-0.27mmol/L [-0.41 至 -0.13]）、低密度脂蛋白（-0.25mmol/L [-0.37 至 -0.13]）、甘油三酯（-0.20mmol/L [-0.28 至 -0.11]）和载脂蛋白 B（-0.13g/L [-0.23 至 -0.03]）的降低以及血清载脂蛋白 A-1 的增加（0.04g/L [0.02-0.07]）有关。此外，植物雌激素补充与血清细胞间黏附分子 1（-18.86ng/mL [-30.06 至 -7.65]）和 E-选择素（-2.32ng/mL [-4.05 至 -0.59]）的降低有关。植物雌激素补充与炎症标志物、纤维蛋白原、同型半胱氨酸或其他内皮功能标志物之间没有关联。相比之下，植物雌激素的使用与 CIMT 的增加有关（9.34μm [95%CI，0.39-18.29]）。无法对植物雌激素补充对氧化应激的影响进行汇总估计。
植物雌激素补充似乎通过影响血液脂质和内皮功能参数，适度改善绝经后妇女的 CVD 风险状况。在动脉粥样硬化风险增加的女性中，尽管幅度较小，但 CIMT 进展可能存在有害影响。由于当前证据的质量有限且性质各异，需要进行更多严格的研究来探索植物雌激素在绝经后心血管健康中的作用。：视频摘要：http://links.lww.com/MENO/A593。
