Peripheral vascular function in stroke: systematic review and meta-analysis

Peripheral vascular dysfunction, measured as flow-mediated dilation (FMD), is present across all phases of stroke recovery and elevates the risk for recurrent cardiovascular events. The objective of this systematic review and meta-analysis was to characterize baseline FMD in individuals' poststroke, with consideration for each phase of stroke recovery. Three databases (PubMed, CINAHL, and Embase) were searched between January 1, 2000 and October 12, 2023 for studies that examined baseline FMD in stroke. Three reviewers conducted abstract and full-text screening, data extraction, and quality assessment. A random effects model was used to estimate FMD across studies. Meta-regression was used to examine the impact of age and time since stroke (acute, subacute, chronic) on FMD. Twenty-eight studies with ischemic and hemorrhagic stroke were included. Descriptive statistics for the demographics and FMD values of each study are presented. For the meta-analysis, average estimate FMD was 3.9% (95% CI: 2.5-5.3%). We report a large amount of heterogeneity (Cochrane's Q P value <0.001, and I2 = 99.6%). Differences in average age and the time poststroke between studies were not significantly associated with differences in FMD values. Despite the large heterogeneity for FMD values across studies, our primary finding suggests that FMD remains impaired across all phases of stroke.NEW & NOTEWORTHY This systematic review and meta-analysis offers invaluable insight into poststroke vascular function. Despite the inherent heterogeneity among the 28 studies analyzed, we report that peripheral vascular dysfunction, as quantified by flow-mediated dilation, exists across all stages of stroke recovery. This finding underscores the importance for interventions that focus on improving vascular health and secondary stroke prevention.

Isoflavones Effects on Vascular and Endothelial Outcomes: How Is the Gut Microbiota Involved?

Isoflavones are a group of (poly)phenols, also defined as phytoestrogens, with chemical structures comparable with estrogen, that exert weak estrogenic effects. These phytochemical compounds have been targeted for their proven antioxidant and protective effects. Recognizing the increasing prevalence of cardiovascular diseases (CVD), there is a growing interest in understanding the potential cardiovascular benefits associated with these phytochemical compounds. Gut microbiota may play a key role in mediating the effects of isoflavones on vascular and endothelial functions, as it is directly implicated in isoflavones metabolism. The findings from randomized clinical trials indicate that isoflavone supplementation may exert putative effects on vascular biomarkers among healthy individuals, but not among patients affected by cardiometabolic disorders. These results might be explained by the enzymatic transformation to which isoflavones are subjected by the gut microbiota, suggesting that a diverse composition of the microbiota may determine the diverse bioavailability of these compounds. Specifically, the conversion of isoflavones in equol-a microbiota-derived metabolite-seems to differ between individuals. Further studies are needed to clarify the intricate molecular mechanisms behind these contrasting results.

Effect of soy isoflavones on C-reactive protein in chronic inflammatory disorders

New evidence suggests that soy products might reduce chronic systemic inflammation. Therefore, we aimed to summarize the effect of soy isoflavones on serum concentration of C-reactive protein (CRP) among participants with chronic inflammatory disorders by conducting this study. Cochrane Library, Scopus, ISI Web of Science, clinicaltrials.gov, and PubMed were searched to identify randomized clinical trials (RCTs) published up to December 2020. The effect size was calculated by the mean change from baseline in concentrations of CRP and its standard deviation for both intervention and comparison groups. DerSimonian and Laird random-effects model was used when the heterogeneity test was statistically significant. In total, thirteen RCTs involving 1213 participants and ten RCTs involving 1052 participants were eligible for our systematic review and meta-analysis respectively. Study duration ranged from 4 to 96 weeks and soy isoflavones dose varied from 33 to 132 mg/day. Overall effect size indicated a non-significant effect on serum concentration of CRP following soy isoflavones intake (weighted mean differences (WMD)=-0.15 mg/L, 95% confidence interval (CI): -0.54, 0.23; p=0.430). Subgroup analysis revealed that soy isoflavones significantly reduced serum concentration of CRP in studies among participants with age >57 years and baseline CRP levels >3.75 mg/L. The present study proposed that soy isoflavones could not significantly reduce serum CRP levels. It seems more RCTs on participants with age more than 57 years and higher levels of CRP is necessary.

Different types of milk consumption and the risk of dementia: Analysis from a large-scale cohort study

BACKGROUND & AIMS

Previous studies have investigated whether milk consumption has a role in preventing the development of cognitive impairment, but the results were inconsistent. Importantly, most of them have disregarded the role of different types of milk. This study aimed to examine the associations between different types of milk consumption and the risk of dementia.

METHODS

In this large-scale cohort study, participants without cognitive impairment at baseline were included from the UK Biobank. The type of milk mainly used was self-reported at baseline, including full-cream milk, skimmed-milk, soy milk, other milk, and no milk. The primary outcome was all-cause dementia. Secondary outcomes included Alzheimer's disease and vascular dementia.

RESULTS

Of the 307,271 participants included in the study (mean age 56.3 [SD 8.1] years), 3789 (1.2%) incident all-cause dementia cases were observed over a median follow-up of 12.3 years. After adjustment for potential confounders, only soy milk consumers had a statistically significantly lower risk of all-cause dementia compared with no milk consumers (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.54 to 0.90). When compared with soy milk non-consumers consisting of full-cream milk, skimmed-milk, and other milk consumers, soy milk consumers still showed a lower risk of all-cause dementia (HR, 0.76; 95% CI, 0.63 to 0.92), and there was no significant interaction with genetic risk for dementia (P for interaction = 0.15). Soy milk consumers showed a lower risk of Alzheimer's disease (HR, 0.70; 95% CI, 0.51 to 0.94; P = 0.02), while the association was not significant for vascular dementia (HR, 0.72; 95% CI, 0.47 to 1.12; P = 0.14).

CONCLUSIONS

The main consumption of soy milk was associated with a lower risk of dementia, particularly non-vascular dementia. Additional studies are needed to investigate how this association varies with the dose or frequency of the consumption of soy milk and to examine the generalizability of these findings in different populations.

The effect of polyphenols in post stroke adults: A systematic review of randomised controlled trials

BACKGROUND

After a stroke, survivors are often left with significant disabilities and are at a greater risk of recurrent strokes. It is vital stroke survivors receive effective treatments to assist with rehabilitation and reduce risk factors for secondary stroke. Observational and preclinical studies have highlighted the promising role of polyphenols in these regards.

METHODS

A systematic review of original research which assessed the role of polyphenols on health outcomes in post stroke adults was conducted. PROQUEST, SCOPUS (Elsevier), MEDLINE (EBSCO), Embase and Cochrane Library databases were searched up to the 29th of October 2021.

RESULTS

A total of 9 studies met the full inclusion criteria and were included in this review. Several classes of polyphenols were assessed including hydroxybenzoic acids, stilbenes and flavonoids. Numerous health outcomes were assessed including vascular function, stroke disability, blood pressure, blood glucose and c-reactive protein. The majority of the studies included in this review (n = 8) note improvements in the polyphenol groups for at least one outcome measure. However, small sample sizes, short trial length and reporting bias prevent firm conclusions from being drawn.

CONCLUSION

This review provides promising preliminary evidence that polyphenols may be beneficial for post stroke adults, however, more research is required. To ensure reliable methodology and replication of results, future studies should include outcome statistics and effect sizes. Trials with a longer duration and large sample size should also be considered.

Multi-Omics Signatures Link to Ticagrelor Effects on Vascular Function in Patients With Acute Coronary Syndrome

BACKGROUND

Long-term antiplatelet agents including the potent P2Y12 antagonist ticagrelor are indicated in patients with a previous history of acute coronary syndrome. We sought to compare the effect of ticagrelor with that of aspirin monotherapy on vascular endothelial function in patients with prior acute coronary syndrome.

METHODS

This was a prospective, single center, parallel group, investigator-blinded randomized controlled trial. We randomized 200 patients on long-term aspirin monotherapy with prior acute coronary syndrome in a 1:1 fashion to receive ticagrelor 60 mg BD (n=100) or aspirin 100 mg OD (n=100). The primary end point was change from baseline in brachial artery flow-mediated dilation at 12 weeks. Secondary end points were changes to platelet activation marker (CD41_62p) and endothelial progenitor cell (CD34/133) count measured by flow cytometry, plasma level of adenosine, IL-6 (interleukin-6) and EGF (epidermal growth factor), and multi-omics profiling at 12 weeks.

RESULTS

After 12 weeks, brachial flow-mediated dilation was significantly increased in the ticagrelor group compared with the aspirin group (ticagrelor: 3.48±3.48% versus aspirin: -1.26±2.85%, treatment effect 4.73 [95% CI, 3.85-5.62], P<0.001). Nevertheless ticagrelor treatment for 12 weeks had no significant effect on platelet activation markers, circulating endothelial progenitor cell count or plasma level of adenosine, IL-6, and EGF (all P>0.05). Multi-omics pathway assessment revealed that changes in the metabolism and biosynthesis of amino acids (cysteine and methionine metabolism; phenylalanine, tyrosine, and tryptophan biosynthesis) and phospholipids (glycerophosphoethanolamines and glycerophosphoserines) were associated with improved brachial artery flow-mediated dilation in the ticagrelor group.

CONCLUSIONS

In patients with prior acute coronary syndrome, ticagrelor 60 mg BD monotherapy significantly improved brachial flow-mediated dilation compared with aspirin monotherapy and was associated with significant changes in metabolomic and lipidomic signatures.

REGISTRATION

URL: https://www.

CLINICALTRIALS

gov; Unique identifier: NCT03881943.

Protective Effects of Flavonoids Against Mitochondriopathies and Associated Pathologies: Focus on the Predictive Approach and Personalized Prevention

Multi-factorial mitochondrial damage exhibits a “vicious circle” that leads to a progression of mitochondrial dysfunction and multi-organ adverse effects. Mitochondrial impairments (mitochondriopathies) are associated with severe pathologies including but not restricted to cancers, cardiovascular diseases, and neurodegeneration. However, the type and level of cascading pathologies are highly individual. Consequently, patient stratification, risk assessment, and mitigating measures are instrumental for cost-effective individualized protection. Therefore, the paradigm shift from reactive to predictive, preventive, and personalized medicine (3PM) is unavoidable in advanced healthcare. Flavonoids demonstrate evident antioxidant and scavenging activity are of great therapeutic utility against mitochondrial damage and cascading pathologies. In the context of 3PM, this review focuses on preclinical and clinical research data evaluating the efficacy of flavonoids as a potent protector against mitochondriopathies and associated pathologies.

Compounds of plants with activity against SARS-CoV-2 targets

Introduction

The COVID-19 global pandemic is a public health emergency due to its high virulence and mortality. Many vaccine development studies at clinical trials are currently conducted to combat SARS-CoV-2. Plants are a rich source of phytochemicals with different biological activities, including antiviral activities, which are the focus of many studies.

Areas covered

This review shows compounds of traditional plants listed on RENISUS list have therapeutic properties against SARS-CoV-2 targets.

Expert Opinion

The rise of new variants, more pathogenic and virulent, impacts in the increase of mortality from SARS-CoV-2 infection, and thus, the control of the outbreaks of disease remains a global challenge. Other’s drug and vaccines development is an essential element in controlling SARS-COV-2. Therefore, it is imperative that approach to tackle this pandemic has to be solidly evidence-informed. It should be noticed that the immune system does play critical roles in fighting viruses. Studies show that T cells levels decreased continuously as the disease progressed. T cell-mediated cellular immune response, probably by immunological memory, is essential for direct virus eradication after infection whilst B cells functions in producing antibodies that neutralize virus.But, have distinct patterns of T cell response exist in different patients, suggesting the possibility of distinct clinical approaches. Efforts are concentrated to elucidate the underlying immunological mechanisms in SARS-CoV-2 pathogenesis and progression for better design of diagnostic, therapeutic and preventive strategies. We seek to identify biomolecules with the potential to act in biomarkers that predict how severe the disease can get. But it is important to warn that the plants that produce the compounds mentioned here should not be used without a physician prescription. Finally, we speculate that these compounds may eventually attract the attention of physicians and researchers to perform tests in specific contexts of SARS-CoV-2 infection, and if they show positive results, be tested in Clinical trials.

Soy intake is associated with lowering blood pressure in adults: A systematic review and meta-analysis of randomized double-blind placebo-controlled trials

BACKGROUND

Soy has several beneficial effects on cardiovascular disease (CVD); however, results of clinical trial studies are equivocal. Thus, the present study sought to discern the efficacy of soy intake on blood pressure.

METHODS

The search process was conducted in PubMed, Scopus, Web of Science, and Cochrane Library, to ascertain studies investigating the efficacy of soy intake on blood pressure in adults, published up to June 2020. A random-effects model was applied to pool mean difference and 95 % confidence interval (CI). Begg's and Egger's methods were conducted to assess publication bias.

RESULTS

Pooled effects from 17 effect sizes revealed a significant improvement in systolic blood pressure (SBP) (-1.70; -3.34 to -0.06 mmHg; I² = 45.4 %) and diastolic blood pressure (DBP) (-1.27; -2.36 to -0.19 mmHg, I² = 43.9 %) following soy consumption, in comparison with controls. Subgroup analysis demonstrated a reduction in both SBP and DBP in younger participants with lower baseline DBP and intervention durations of <16 weeks.

CONCLUSION

Our results suggest that soy intake is associated with an ameliorating effect on blood pressure in adults.

The effects of soy supplementation on inflammatory biomarkers: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Soy products contain several compounds with anti-inflammatory properties like genistein and daidzein which reported to act through different pathways. Present study conducted considering the inconsistent results and lack of any comprehensive review regarding randomized controlled trials which assess the effect of soy products on inflammatory markers.

METHODS

Following electronic databases were searched up to March 2020: PubMed, Scopus, ISI web of science, and Cochrane Library All randomized trials which assessed the effect of soy product supplementation on c-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) were included for last analysis. Treatment effects were expressed as mean difference (MD) and the standard deviation (SD) of outcomes. To estimate the overall effect the random-effects model was employed.

RESULTS

Finally, 51 randomized trial were included for present study. Last analysis showed that soy product supplementation lead to significant reduction in CRP (MD -0.27 mg/L; 95% CI: -0.51, -0.02, p = 0.028) but it did not affect IL-6 (MD 0.0 pg/ml; 95% CI: -0.06, 0.06, p = 0.970) and TNF-α (MD = -0.04 pg/ml; 95% CI: -0.11, 0.03, p = 0.252). Subgroup analysis showed that soy supplementation had a significant impact on decreasing IL-6 and TNF-α levels when studies had a long-term intervention (≥12 weeks) and used low dose isoflavone (<100 mg/day).

CONCLUSION

In conclusion, present systematic review and meta-analysis found a significant reduction in CRP levels after soy supplementation whiles IL-6 and TNF-α did not affect.

A systematic review and meta-analysis of the effects of soy on serum hs-CRP

BACKGROUND & AIM

The results of studies about the effect of soy products on serum highly sensitive C-reactive protein (hs-CRP) are inconsistent. The aim of this systematic review and meta-analysis of randomized clinical trials (RCTs) was to investigate the effect of soy products intake on serum hs-CRP concentration.

METHODS

We searched PubMed, EMBASE, Science Direct, ISI Web of Science, Google Scholar and Cochrane Central Register of Controlled Trials up to December 2016 without language restrictions. Random-effect model was used for quantitative data synthesis.

RESULTS

Thirty-six studies were included in our analyses. A meta-analysis revealed a non-significant reduction in serum hs-CRP concentrations following soy products consumption, -0.19 (mg/L) (95% CI: -0.49 to 0.09; I2 = 95.6%). Subgroup analyses suggested that natural soya products may reduce plasma levels of CRP by -0.18 mg/L (95% CI: -0.28 to -0.08; I2: 11.6) in comparison to other source of isoflavones (soya extracts, supplements). Moreover, the effect was stronger among subjects with baseline hs-CRP concentrations of less than 2.52 mg/L, -0.15 (95% CI: -0.27 to -0.02; I2: 34.6). A meta-regression analysis revealed that dosage of isoflavones seems to be a strong predictor of the effect of soya on serum hs-CRP levels.

CONCLUSION

Present review of RCTs published up to December 2016 did not provide strong evidence regarding the beneficial effect of soya products consumption on blood hs-CRP concentrations. However, it appears that natural soya products may reduce plasma levels of hs-CRP in comparison to other source of isoflavones. Large and well-designed studies are recommended to confirm this conclusion.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018069371.

Clinical Advances in Immunonutrition and Atherosclerosis: A Review

Atherosclerosis is a chronic low-grade inflammatory disease that affects large and medium-sized arteries and is considered to be a major underlying cause of cardiovascular disease (CVD). The high risk of mortality by atherosclerosis has led to the development of new strategies for disease prevention and management, including immunonutrition. Plant-based dietary patterns, functional foods, dietary supplements, and bioactive compounds such as the Mediterranean Diet, berries, polyunsaturated fatty acids, ω-3 and ω-6, vitamins E, A, C, and D, coenzyme Q10, as well as phytochemicals including isoflavones, stilbenes, and sterols have been associated with improvement in atheroma plaque at an inflammatory level. However, many of these correlations have been obtained in vitro and in experimental animals' models. On one hand, the present review focuses on the evidence obtained from epidemiological, dietary intervention and supplementation studies in humans supporting the role of immunonutrient supplementation and its effect on anti-inflammatory response in atherosclerotic disease. On the other hand, this review also analyzes the possible molecular mechanisms underlying the protective action of these supplements, which may lead a novel therapeutic approach to prevent or attenuate diet-related disease, such as atherosclerosis.

Acceptability and consumption of tofu as a meat alternative among secondary school boarders in Enugu State, Nigeria: Implications for nutritional counseling and education

Tofu, a food made of condensed soymilk that originated in China, has both nutritional and health benefits. The main objective of this study was to determine the acceptability and consumption of tofu as a meat alternative among students in boarding secondary schools in Enugu State, Nigeria.In this study, the authors adopted a cross-sectional analytic design. A representative sample of 603 adolescents in the boarding secondary schools took part in the study. Power analysis was conducted to estimate the appropriate sample size for the current study. Correlations analysis, moderation analysis, χ, analysis of variance (ANOVA), and t tests were employed for the analysis of the data.Students' acceptance of the 3 cooking options of tofu (steamed, boiled, and fried) did not significantly differ by gender. It was found that 94.5% of the respondents recognized the benefits of tofu; there is no significant difference between the male and female students on the extent to which they would eat tofu in school; the recognition of benefits of tofu is not significantly associated with acceptance of steamed, boiled, and fried tofu among the students; and the recognition of benefits of tofu is not significantly associated with consumption of tofu among the students. The finding further revealed that gender did not significantly moderate the association between recognition of benefits of tofu and students' acceptability of tofu. Also, it was found that gender did not significantly moderate the association between recognition of benefits of tofu and consumption of tofu among students.Further research is needed to identify the level of tofu acceptability and consumption among adolescents in boarding secondary schools in other states of Nigeria. Further research on factors influencing how recognition of benefits of tofu is associated with its acceptability among the Nigerian student population can have implications for nutritional counseling and regional health.

Polyphenol protection and treatment of hypertension

INTRODUCTION

High blood pressure is the major risk factor for cardiovascular diseases and the rising prevalence of human hypertension precedes the trend toward a global epidemic of unhealthy ageing. A focus on lifestyle and dietary interventions minimizes dependency on pharmacological antihypertensive therapies.

REVIEW

Observational studies indicate that the intake of dietary flavonoids is associated with a decreased risk of cardiovascular disease (CVD). The evidence suggests that the dietary intakes of polyphenol-rich foods, herbs and beverages including flavonols, anthocyanidins, proanthocyanidins, flavones, flavanones, isoflavones and flavan-3-ols, improves vascular health, thereby significantly reducing the risk of hypertension and CVD. Consumption is associated with an improvement in endothelial function via vascular eNOS and Akt activation. Increased NO bioavailability improves vasodilation and blood circulation, effects protein kinases, ion channels and phosphodiesterases, counteracting vascular inflammation and LDL oxidative stress. Importantly, some polyphenols also inhibit the activity of matrix metalloproteinases, inhibit angiotensin converting enzyme activity and thereby improving SBP and DSB. We review the improvement of polyphenol intake on blood pressure and endothelial function for the treatment of hypertension, including not only observational but also RCTs and pre-clinical studies.

CONCLUSION

The antihypertensive phytotherapy of polyphenol-rich foods for protection and improving endothelial function with vascular relaxation occurs via the NO-cGMP pathway and ACE inhibition. OPCs stimulate endothelium-dependent vasodilation, suppress vasoconstrictor ET-1 synthesis, activate a laminar shear stress response in endothelial cells and also inhibit the activity of metalloproteinases including ACE lowering blood pressure.

A Systematic Review of the Efficacy of Bioactive Compounds in Cardiovascular Disease: Phenolic Compounds

The prevalence of cardiovascular diseases (CVD) is rising and is the prime cause of death in all developed countries. Bioactive compounds (BAC) can have a role in CVD prevention and treatment. The aim of this work was to examine the scientific evidence supporting phenolic BAC efficacy in CVD prevention and treatment by a systematic review. Databases utilized were Medline, LILACS and EMBASE, and all randomized controlled trials (RCTs) with prospective, parallel or crossover designs in humans in which the effects of BAC were compared with that of placebo/control were included. Vascular homeostasis, blood pressure, endothelial function, oxidative stress and inflammatory biomarkers were considered as primary outcomes. Cohort, ecological or case-control studies were not included. We selected 72 articles and verified their quality based on the Scottish Intercollegiate Guidelines Network, establishing diverse quality levels of scientific evidence according to two features: the design and bias risk of a study. Moreover, a grade of recommendation was included, depending on evidence strength of antecedents. Evidence shows that certain polyphenols, such as flavonols can be helpful in decreasing CVD risk factors. However, further rigorous evidence is necessary to support the BAC effect on CVD prevention and treatment.

A select review reporting the quality of studies measuring endothelial dysfunction in randomised diet intervention trials

A quality assessment of the primary studies reported in the literature carried out using select dietary ingredients (DI) purported to affect vascular endothelial function was conducted through a systematic PubMed search from January 2000 to August 2012. A total of seventy randomised controlled trials with defined DI (folic acid (fifteen), n-3 fatty acids (twenty), cocoa (fifteen) and isoflavones (twenty)) and standardised measures of vascular endothelial function were evaluated. Jadad scores, quality scoring parameters for DI and flow-mediated dilation (FMD) methodology used were ascertained. A total of 3959 randomised subjects, mean age 51 (se 0·21) years (range 9-79 years), were represented in the dataset. The mean Jadad scores did not differ statistically among the DI studies, with the majority of the studies being of good quality. Higher DI quality scores were achieved by studies using the botanical ingredients cocoa and isoflavones than by those using the nutrient ingredients folic acid and n-3 fatty acids. The mean DI quality scores were 4·13 (se 0·34), 5·20 (se 0·47), 6·13 (se 0·41) and 6·00 (se 0·59) for the folic acid, n-3 fatty acid, cocoa and isoflavone intervention studies, respectively (and significantly different). The mean Corretti FMD scores were 7·27 (se 0·56), 7·46 (se 0·79), 6·29 (se 0·61) and 7·11 (se 0·56) for the folic acid, n-3 fatty acid, cocoa and isoflavone intervention studies, respectively (NS). FMD studies failed to adequately describe the equipment used and more than half failed to provide an adequate description of the procedures used for vascular image acquisition and measurement. DI can be utilised for dietary intervention studies; however, the methodology should be clearly reported using the guidelines for assessment for both DI and FMD.

Distinct role of estrogen receptor-alpha and beta on postmenopausal diabetes-induced vascular dysfunction

Estrogen is known to influence vascular functions and insulin sensitivity, but the relative contribution of estrogen receptor (ER) isoforms in postmenopausal diabetes-induced vascular dysfunction is unclear. The aim of the present study was to delineate the distinct role of estrogen receptor-α and beta β on the vascular function in ovariectomized diabetic rats. Age matched 60 female sprague dawley rats (200-250g) were divided in nine groups. Bilateral ovariectomy was performed and streptozotocin was used to induce experimental diabetes. Rats were administered with 10μg/kg; s.c. of a nonselective estrogen receptor agonist, 17-β estradiol (E2), selective ER-α agonist (4,4',4″-(4-propyl-[1H] pyrazole-1,3,5-triyl) tris phenol (PPT) and selective ER-β agonist, 2,3-bis(4-hydroxyphenyl)-propionitrile (DPN) for 4weeks after STZ injection. Treatment with selective ER-α agonist and E2 improved the impaired glycemic and lipid profile in ovariectomized diabetic rats, however selective ER-β agonist did not show any effect. Vascular endothelial dysfunction was assessed by acetylcholine and sodium nitroprusside-induced endothelium dependent and independent relaxation in isolated rat aortic ring preparation as well as by electron microscopy of thoracic aorta. Further, serum thiobarbituric acid reactive substances, tumour necrotic factor-alpha and interleukin-1 beta and C-reactive protein were estimated to assess oxidative stress and vascular inflammation. Treatment with ER-α agonist markedly and E2 partially improved vascular function and endothelial integrity along with reduction in serum TBARS and inflammatory cytokines. However, ER-β agonist did not show any improvement in vascular functions, oxidative stress or inflammation. These findings suggest that selective targeting of ER-α receptors results in vasculoprotection in the state of hypoestrogenicity and diabetes.

Soy proteins and isoflavones reduce interleukin-6 but not serum lipids in older women: a randomized controlled trial

Soy foods contain several components, notably, isoflavones and amino acids, that may improve cardiovascular health. We evaluated the long-term effect of soy protein and/or soy isoflavones supplementation on serum lipids and inflammatory markers using a 1-year randomized, double-blind, placebo-control, clinical trial in 131 healthy ambulatory women older than 60 years. We hypothesized that soy protein, in combination with isoflavones, would have the largest positive effect on coronary heart disease risk factors (serum lipids and inflammatory markers) compared with either intervention alone and that, within groups receiving isoflavones, equol producers would have more positive effects on coronary heart disease risk factors than nonequol producers. After a 1-month baseline period, participants were randomized into 1 of 4 intervention groups: soy protein (18 g/d) and isoflavone tablets (105 mg/d isoflavone aglycone equivalents), soy protein and placebo tablets, control protein and isoflavone tablets, or control protein and placebo tablets. T Tests were used to assess differences between equol and nonequol producers. Ninety-seven women completed the trial. Consumption of protein powder and isoflavone tablets did not differ among groups, and compliance with study powder and tablets was 79% and 90%, respectively. After 1 year, in the entire population, there were either no or little effects on serum lipids and inflammatory markers, regardless of treatment group. Equol producers, when analyzed separately, had significant improvements in total cholesterol/high-density lipoprotein and low-density lipoprotein/high-density lipoprotein ratios (-5.9%, P = .02; -7.2%, P = .04 respectively). Soy protein and isoflavone (either alone or together) did not impact serum lipids or inflammatory markers. Therefore, they should not be considered an effective intervention to prevent cardiovascular disease because of lipid modification in healthy late postmenopausal women lacking the ability to produce equol.

Association of subclinical myocardial injury with arterial stiffness in patients with type 2 diabetes mellitus

Objective

Type 2 diabetes mellitus (T2DM) is associated with subclinical myocardial injury although the underlying mechanism is uncertain. We postulated that arterial stiffness, endothelial dysfunction and subclinical atherosclerosis may contribute to subclinical myocardial injury in patients with T2DM.

Methods

Serum high-sensitivity troponin I (hs-TNI) an indicator of myocardial injury, was measured in 100 patients with T2DM without clinical evidence of macrovascular disease and 150 age and gender-matched controls. Elevated hs-TnI was defined as follow (derived from the 99^th percentile from controls): Male >11.1 ng/L; female >7.6 ng/L. Measures that may contribute to myocardial damage in patients with T2DM, including brachial-ankle pulse wave velocity (ba-PWV), brachial flow mediated dilatation (FMD) and carotid intima media thickness (IMT), were also assessed.

Results

The serum level of hs-TNI (5.7±9.2 μg/L vs. 3.2±1.9 μg/L, P< 0.01) and the prevalence of elevated hs-TNI (12% vs. 4%, P = 0.02) were significantly higher in patients with T2DM than controls. Patients with T2DM also had significantly worse ba-PWV (17.98±3.91ms^-1 vs. 15.70±2.96 ms^-1), brachial FMD (2.6±3.5% vs. 5.5±4.2%, P< 0.01) and carotid IMT (0.96±0.20 mm vs. 0.86±0.14 mm, P< 0.01). In patients with T2DM, hs-TNI was positively correlated with systolic blood pressure (r = 0.31, P<0.01), serum creatinine (r = 0.26, P = 0.01) and ba-PWV (r = 0.34, P< 0.01). Importantly, multiple regression revealed that only ba-PWV was independently associated with hs-TNI (β = 0.25, P = 0.04).

Conclusion

The results demonstrated an independent association between ba-PWV and hs-TNI in patients with T2DM with no clinical evidence of macrovascular disease. These findings suggest that increased arterial stiffness is closely related to subclinical myocardial injury in patients with T2DM.

Soy isoflavone: The multipurpose phytochemical (Review)

Soy isoflavones are compounds found in soybean and soybean products. They have been reported to possess numerous physiological properties, such as antitumor, anti-menopausal (female) osteoporosis and anti-aging. They have also been reported to improve learning and memory skills in menopausal women and aid in the prevention and treatment of heart disease, diabetes and Kawasaki disease (KD). In this review, the effects of soy isoflavones on various diseases were analyzed. Based on the analysis, it was hypothesized that the function of soybean isoflavones in the prevention and treatment of various diseases results from their phytoestrogen and antioxidant properties. However, due to their phytoestrogen properties, it is recommended that the risks of soy isoflavone intake as food and/or medical treatment be further evaluated.

Prevalence and extent of subclinical atherosclerosis in patients with psoriasis

OBJECTIVE

Patients with psoriasis are prone to premature atherosclerosis and increased risk of cardiovascular disease events. However, the prevalence and extent of atherosclerosis in patients with psoriasis are unknown.

DESIGN

A cross-sectional study.

SETTING AND SUBJECTS

The prevalence and extent of coronary and carotid atherosclerosis were compared in 70 patients with psoriasis (46 ± 9 years, 71% male) without known cardiovascular disease or joint involvement and 51 age- and gender-matched healthy control subjects (45 ± 7 years, 71% male). Systemic inflammation was assessed by the level of high-sensitivity C-reactive protein (hs-CRP). Coronary atherosclerosis was determined by the coronary calcification score (CCS) measured by multi-detector computed tomography. Carotid atherosclerosis was assessed by high-resolution ultrasound-derived carotid intima-media thickness (cIMT).

RESULTS

Patients with psoriasis had a higher prevalence of coronary atherosclerosis (CCS > 0; 28.6% vs. 3.9%, P < 0.01), and a higher degree of coronary atherosclerosis estimated by the mean CCS (67.4 ± 349.2 vs. 0.5 ± 3.0, P < 0.05) compared with controls. Similarly, cIMT was significantly greater in patients with psoriasis than in control subjects (0.73 ± 0.11 mm vs. 0.67 ± 0.08 mm, P < 0.01). Multiple logistic regression revealed that psoriasis [odd ratio (OR): 10.54, 95% confidence interval (CI) 1.89-58.67, P < 0.01] and serum total cholesterol level (OR 2.10, 95% CI 1.01-4.37) were associated with the presence of coronary atherosclerosis (CCS > 0). By contrast, only age was independently associated with increased cIMT. Amongst participants with no traditional cardiovascular disease risk factors, hs-CRP level was higher in patients with psoriasis than in controls.

CONCLUSION

The present results demonstrate early-onset, diffuse arterial atherosclerosis in coronary and carotid arteries in patients with psoriasis, but not in age- and gender-matched control subjects. Low-grade inflammation could explain the presence of premature atherosclerosis in patients with psoriasis.

Prolongation of PR interval is associated with endothelial dysfunction and activation of vascular repair in high-risk cardiovascular patients

PURPOSE

Epidemiological studies showed that PR prolongation is associated with increased risk of adverse cardiovascular outcomes. We investigated the relations of PR interval with indices of vascular function and endothelial repair as the underlying mechanisms.

METHODS

The study comprised 348 high-risk patients with prior coronary artery disease, ischemic stroke, and/or diabetes mellitus recruited from medical outpatient clinics and 150 healthy subjects without such a history. PR interval was considered prolonged if >200 ms, as determined from resting 12-lead electrocardiogram. Vascular function was assessed by brachial flow-meditated dilatation (FMD) using high-resolution ultrasound. Circulating CD133(+)/KDR(+) endothelial progenitor cell (EPC) levels were measured by flow cytometry.

RESULTS

Among healthy subjects, PR interval was inversely associated with FMD (R = -0.20, P = 0.015), but not with the level of circulating CD133(+)/KDR(+) EPC (R = 0.05, P = 0.58). Among high-risk cardiovascular patients, PR prolongation >200 ms was more common compared with healthy subjects (45/348 (13 %) versus 4/150 (3 %), P < 0.001). PR interval was associated inversely with FMD (R = -0.14, P = 0.01) and positively with circulating CD133(+)/KDR(+) EPC level (R = +0.14, P = 0.009). Circulating CD133(+)/KDR(+) EPC level was significantly increased in patients with PR prolongation >200 ms (0.87 ± 0.37 versus 0.68 ± 0.42 (log, ×10(-3)/ml), P = 0.005). Adjusted for potential confounders, increased PR interval remained independently associated with increased CD133(+)/KDR(+) EPC by +0.002 (95 % confidence interval (CI) 0.000 to 0.004 (log, ×10(-3)/ml), P = 0.011) and depressed FMD (B = -0.014 %, 95 % CI -0.027 to -0.002, P = 0.026).

CONCLUSIONS

PR prolongation is associated with endothelial dysfunction and evidence of endothelial repair activation in patients with high cardiovascular risk.

Increased dietary fruit intake was associated with lower burden of carotid atherosclerosis in Chinese patients with Type 2 diabetes mellitus

BACKGROUND

Previous studies demonstrated that high fruit consumption was associated with a lower risk of cardiovascular events in patients with Type 2 diabetes mellitus. However, the relationship between fruit intake and carotid atherosclerosis in these patients is unknown. We studied the relationship between dietary fruit intake and carotid intima-media thickness in patients with Type 2 diabetes.

METHODS

A total of 255 Chinese patients with Type 2 diabetes were recruited. Dietary fruit intake was assessed by a validated food-frequency questionnaire, and carotid intima-media thickness was measured by high-resolution ultrasonography.

RESULTS

Among patients with three different tertiles of fruit intake (14.5 ± 8.6 vs. 41.5 ± 7.1 vs. 92.6 ± 39.7 g/day), there was no difference in their clinical characteristics (all P > 0.05). Patients with the highest tertile of fruit intake had a significantly higher BMI and diastolic blood pressure than those with the lowest tertile intake. Furthermore, serum high-sensitivity C-reactive protein, 8-isoprostane and superoxide dismutase were similar among the three tertiles of patients (all P > 0.05). However, patients with the highest tertile of fruit intake had lower carotid intima-media thickness (0.97 ± 0.02 vs. 1.08 ± 0.03 mm, P = 0.046) and prevalence of carotid plaque (11.76 vs. 1.18%, P = 0.022) than those with the lowest tertile of fruit intake. Multivariate regression analysis revealed the highest tertile of fruit intake (β = -0.086, P = 0.049) was independently associated with carotid intima-media thickness.

CONCLUSIONS

Our results demonstrated that, in Chinese patients with Type 2 diabetes, higher dietary fruit intake was associated with a lower burden of carotid atherosclerosis as reflected by lower carotid intima-media thickness and prevalence of carotid plaque.

Randomized controlled trial of vitamin D supplement on endothelial function in patients with type 2 diabetes

BACKGROUND

Suboptimal vitamin D status is associated with endothelial dysfunction and an increased risk of cardiovascular diseases but it is unclear whether vitamin D supplementation is beneficial. The aim was to investigate the effect of vitamin D supplementation on endothelial function in patients with type 2 diabetes mellitus (DM).

METHODS

In a double-blind, placebo-controlled trial, we randomized 100 type 2 DM patients to vitamin D supplement (5000 IU/day, n = 50) or placebo (controls, n = 50) for 12 weeks. Assessment of vascular function with brachial artery flow-mediated dilatation (FMD), circulating levels of endothelial progenitor cells (EPCs) and brachial-ankle pulse wave velocity, and metabolic parameter, high-sensitivity C-reactive protein (hsCRP) and oxidative stress markers were performed before and after the supplementation.

RESULTS

After 12 weeks, vitamin D treated patients had significant increases in serum 25-hydroxyvitamin D [25(OH)D] concentration (treatment effect 34.7 ng/mL, 95% CI 26.4-42.9, P < 0.001) and serum ionized calcium (treatment effect 0.037 mmol/L, 95% CI 0.007-0.067, P = 0.018); decreased serum parathyroid hormone concentration (treatment effect -0.55 pmol/L, 95% CI -1.08 to -0.02, P = 0.042) compared to patients who received placebo. Nevertheless, vitamin D supplementation did not improve vascular function as determined by FMD, circulating EPC count or baPWV (all P > 0.05). Furthermore, hsCRP, oxidative stress markers, low- and high-density lipoprotein and glycated hemoglobin were also similar between two groups (all P > 0.05).

CONCLUSION

In patients with type 2 DM, 12 weeks oral supplementation of vitamin D did not significantly affect vascular function or serum biomarkers of inflammation and oxidative stress.

CLINICAL TRIAL NUMBER

HKCTR-867, www.hkclinicaltrials.com.

Associations between flavonoids and cardiovascular disease incidence or mortality in European and US populations

Twenty publications from twelve prospective cohorts have evaluated associations between flavonoid intakes and incidence or mortality from cardiovascular disease (CVD) among adults in Europe and the United States. The most common outcome was coronary heart disease mortality, and four of eight cohort studies reported significant inverse associations for at least one flavonoid class (multivariate adjusted p(trend) < 0.05). Three of seven cohorts reported that greater flavonoid intake was associated with lower risk of incident stroke. Comparisons among the studies were difficult because of variability in the flavonoid classes included, demographic characteristics of the populations, outcomes assessed, and length of follow-up. The most commonly examined flavonoid classes were flavonols and flavones combined (11 studies). Only one study examined all seven flavonoid classes. The flavonol and flavone classes were most strongly associated with lower coronary heart disease mortality. Evidence for protection from other flavonoid classes and CVD outcomes was more limited. The hypothesis that flavonoid intakes are associated with lower CVD incidence and mortality requires further study.

Evolution of phenolic compounds from color and flavor problems to health benefits

Early studies focused on the negative effects on color and flavor of foods, followed by exploration of the antioxidant properties and the associated health benefits. The growing body of evidence suggests that plant-based polyphenols may help prevent or delay the onset of a multiplicity of diseases. Newer work suggests that a variety of polyphenols can alter the expression of genes in the inflammatory pathway. Data also show that the absorption of the polyphenols is very limited. Insulin resistance and endothelial and mitochondrial dysfunction are hallmarks of the metabolic syndrome and aging and occur at the early stages of the disease. There is limited clinical evidence that certain polyphenolic metabolites by virtue of their anti-inflammatory activities can improve insulin sensitivity and endothelial and mitochondrial function, suggesting that polyphenols are good for disease prevention. The goal of this review is to summarize the evolution and emphasize the potential benefits of polyphenols.

Effect of soy isoflavones on circulating C-reactive protein in postmenopausal women: meta-analysis of randomized controlled trials

Strong evidence suggests that C-reactive protein (CRP) is a novel risk factor for cardiovascular disease. We aimed to examine the effect of soy isoflavones on circulating CRP concentrations in postmenopausal women by conducting a meta-analysis of randomized controlled trials. We performed a literature search using PubMed, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases in December 2010 for randomized controlled trials conducted in postmenopausal women, using soy foods with isoflavones or isoflavone extracts as treatment, and with a report of CRP change. A meta-analysis was performed using a fixed-effects model or a random-effects model to calculate the combined effect size. In addition, subgroup and metaregression analyses were carried out to examine the influences of study designs and participant characteristics on the effect estimates. A pooled analysis of 14 trials showed a slight, but not significant, reduction of 0.17 mg/L (95% CI, -0.38 to 0.04; P = 0.12) in CRP concentrations among postmenopausal women with soy isoflavone intervention compared with controls. No substantial heterogeneity was observed. Subgroup analyses showed that soy isoflavones significantly lowered CRP by 0.70 mg/L (95% CI, -1.17 to -0.23; P = 0.003) among women with baseline CRP concentrations greater than 2.2 mg/L. No significant changes in CRP were observed in the other subgroups. Metaregression analysis further revealed that baseline CRP was a potential effect modifier of isoflavone treatment in lowering CRP. The present meta-analysis found insufficient evidence that soy isoflavones significantly reduce CRP concentrations in postmenopausal women. However, soy isoflavones may produce a significant reduction in CRP among postmenopausal women with elevated CRP.

Prospective observational study of isoflavone and the risk of stroke recurrence: potential clinical implications beyond vascular function

BACKGROUND

Whether isoflavone has any effect on recurrent cardiovascular events is unknown.

OBJECTIVE

To investigate the relations between isoflavone intake and the risk of stroke recurrence.

SUBJECTS AND METHODS

We recruited 127 consecutive patients with prior history of atherothrombotic/ hemorrhagic stroke (mean age: 67 ± 11 years, 69% male) and prospectively followed up for a mean duration of 30 months. Stroke recurrence and major adverse cardiovascular events (MACE) were documented. Brachial flow-mediated dilatation (FMD) was measured using high-resolution ultrasound. Isoflavone intake was estimated using a validated food frequency questionnaire.

RESULTS

Median isoflavone intake was 6.9 (range: 2.1 - 14.5) mg/day. Isoflavone intake was independently associated with increased FMD (Pearson R=0.23, p=0.012). At 30 months, there were 10 stroke recurrence and 12 MACE. Kaplan-Meier analysis showed that patients with isoflavone intake higher than median value had significantly longer median stroke recurrence-free survival time (19.0 [range: 10.4 - 27.6] mth versus 5.0 [range: 4.1 - 5.9] mth, p=0.021) and MACE-free survival time (19.0 [range: 10.4 - 27.6] mth versus 4.0 [range: 2.4 - 5.6] mth, p=0.013). Using multivariate cox regression, higher isoflavone intake was an independent predictor for lower risk of stroke recurrence (hazards ratio 0.18 [95%CI: 0.03 - 0.95], risk reduction 82%, p=0.043) and MACE (hazards ratio 0.16 [95%CI: 0.03 - 0.84], risk reduction 84%, p=0.030).

CONCLUSIONS

Higher isoflavone intake in stroke patients was associated with prolonged recurrence-free survival, and reduced risk of stroke recurrence and MACE independent of baseline vascular function. Whether isoflavone may confer clinically significant secondary protection in stroke patients should be further investigated in a randomized controlled trial.

Evidence for a protective effect of polyphenols-containing foods on cardiovascular health: an update for clinicians

Growing evidence suggests that polyphenols could be serious candidates to explain the protective effects of plant-derived foods and beverages. Based on current studies, a general consensus has been achieved to sustain the hypothesis that the specific intake of foods and beverages containing relatively high concentrations of flavonoids may play a meaningful role in reducing cardiovascular disease (CVD) risk through an improvement in vascular function and a modulation of inflammation. This review aims at providing an update on the effects of the consumption of polyphenols-rich foods on intermediate clinical markers of CVD in humans, namely cholesterolemia, blood pressure, endothelial function and platelet function. To date, on the basis of clinical studies, the demonstration is particularly convincing for flavonoids from cocoa-derived products and to a lesser extent for those of tea. While additional studies in this area are clearly needed, incorporating plant foods that are rich in flavanols in the diet of healthy individuals could help to reduce CVD risk. For flavonoids from fruits such as berries, pomegranate, grapes or citrus fruits and those from beverages such as red wine or coffee, the evidence is so far inconclusive. This is primarily due to the limited number and the weakness of experimental designs of the studies performed with these dietary sources. Future long-term well-designed investigations with polyphenols-rich foods but also with isolated phenolic compounds would provide valuable information to establish public health recommendations on polyphenols, taking into account both the nature of the compounds and the optimal dose, for cardiovascular health protection.

Exposure to isoflavone-containing soy products and endothelial function: a Bayesian meta-analysis of randomized controlled trials

BACKGROUND AND AIMS

To determine whether and to what degree exposure to isoflavone-containing soy products affects EF. Endothelial dysfunction has been identified as an independent coronary heart disease risk factor and a strong predictor of long-term cardiovascular morbidity and mortality. Data on the effects of exposure to isoflavone-containing soy products on EF are conflicting.

METHODS AND RESULTS

A comprehensive literature search was conducted using the PUBMED database (National Library of Medicine, Bethesda, MD) inclusively through August 21, 2009 on RCTs using the keywords: soy, isoflavone, phytoestrogen, EF, flow mediated vasodilation, and FMD. A Bayesian meta-analysis was conducted to provide a comprehensive account of the effect of isoflavone-containing soy products on EF, as measured by FMD. A total of 17 RCTs were selected as having sufficient data for study inclusion. The overall mean absolute change in FMD (95% Bayesian CI) for isoflavone-containing soy product interventions was 1.15% (-0.52, 2.75). When the effects of separate interventions were considered, the treatment effect for isolated isoflavones was 1.98% (0.07, 3.97) compared to 0.72% (-1.39, 2.90) for isoflavone-containing soy protein. The models were not improved when considering study-specific effects such as cuff measurement location, prescribed dietary modification, and impaired baseline FMD.

CONCLUSIONS

Cumulative evidence from the RCTs included in this meta-analysis indicates that exposure to soy isoflavones can modestly, but significantly, improve EF as measured by FMD. Therefore, exposure to isoflavone supplements may beneficially influence vascular health.

Abnormal vascular function in PR-interval prolongation

BACKGROUND

Underlying mechanisms of PR-interval prolongation leading to increased risk of adverse cardiovascular outcomes, including atrial fibrillation, are unclear. This study aims to investigate the relation between PR interval and changes in vascular function.

HYPOTHESIS

We hypothesize that there exists an intermediate pathological stage between electrocardiographic PR prolongation and adverse cardiovascular outcomes, which could be reflected by changes in surrogate measurements of vascular function.

METHODS

We recruited 88 healthy subjects (mean age 57.5 ± 9.8 y, 46% male) from a community-based health screening program who had no history of cardiovascular disease or diabetes mellitus. PR interval was determined from a resting 12-lead electrocardiogram. Vascular function was noninvasively assessed by flow-mediated dilation (FMD) using high-resolution ultrasound and brachial-ankle pulse wave velocity (PWV) using a vascular profiling system.

RESULTS

Only 3 subjects had a PR-interval length longer than the conventional cutoff of 200 ms. The PR-interval length was associated inversely with FMD (Pearson r = -0.30, P = 0.004) and positively with PWV (r = 0.40, P < 0.001). Adjusting for potential confounders, increased PR-interval length by each 25 ms was independently associated with reduced FMD by -1 unit (absolute %, B = -0.04 [95% confidence interval: -0.080 to -0.002, P = 0.040)] and increased PWV by +103 cm/second (B = +4.1 [95% confidence interval: 0.6-7.6, P = 0.023]).

CONCLUSIONS

This study shows that PR-interval length, even in the conventionally normal range, is independently associated with endothelial dysfunction and increased arterial stiffness in healthy subjects free of atherosclerotic disease. This suggests the presence of a systemic, intermediate pathologic stage of the vasculature in PR prolongation before clinically manifest cardiovascular events, and could represent a mediating mechanism.

Adverse systemic arterial function in patients with selenium deficiency

BACKGROUND

Experimental studies have shown that selenium is involved in the synthesis of selenoproteins which might contribute to cardiovascular protection. However, the relationship between selenium deficiency and vascular function in clinical context remains unknown.

OBJECTIVE

To investigate for any relationship between selenium deficiency and systemic arterial function in patients with high risk of vascular events.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

306 consecutive patients with high risk for cardiovascular events (coronary artery disease 35%, acute/ recurrent ischemic stroke 40%, diabetes mellitus 54%) followed up at internal medicine outpatient clinics.

MEASUREMENTS

Non-invasive brachial-ankle pulse wave velocity (PWV) was determined using vascular profiling system (VP-2000). Long-term intake of selenium was determined by a validated food frequency questionnaire.

RESULTS

Mean daily selenium intake was 59.5 ± 52.1 mcg/day, and mean PWV was 1782.4 ± 418.4 cm/s. Patients with selenium intake <10th percentile had significantly higher PWV as compared to patients with intake ≥ 10th percentile (1968.2 ± 648.9 cm/s versus 1762.2 ± 381.6 cm/s, P=0.010). After adjusting for potential confounders including age, gender, history of hypertension, hyperlipidemia, diabetes and cardiovascular disease, smoking status, use of cardiovascular medications, waist-hip ratio, education/ financial status, physical activity, calorie intake and intake of antioxidant vitamins, deficient selenium intake <10th percentile remained independently predictive of increased PWV by +363.4 cm/s [95% CI: 68.1 to 658.6, P=0.016, relative increase 21%].

CONCLUSIONS

Selenium deficiency is associated with adverse arterial function in patients with high risk for vascular events.

Effect of soya protein on blood pressure: a meta-analysis of randomised controlled trials

Observational studies have indicated that soya food consumption is inversely associated with blood pressure (BP). Evidence from randomised controlled trials (RCT) on the BP-lowering effects of soya protein intake is inconclusive. We aimed to evaluate the effectiveness of soya protein intake in lowering BP. The PubMed database was searched for published RCT in the English language through to April 2010, which compared a soya protein diet with a control diet. We conducted a random-effects meta-analysis to examine the effects of soya protein on BP. Subgroup and meta-regression analyses were performed to explore possible explanations for heterogeneity among trials. Meta-analyses of twenty-seven RCT showed a mean decrease of 2·21 mmHg (95 % CI - 4·10, - 0·33; P = 0·021) for systolic BP (SBP) and 1·44 mmHg (95 % CI - 2·56, - 0·31; P = 0·012) for diastolic BP (DBP), comparing the participants in the soya protein group with those in the control group. Soya protein consumption significantly reduced SBP and DBP in both hypertensive and normotensive subjects, and the reductions were markedly greater in hypertensive subjects. Significant and greater BP reductions were also observed in trials using carbohydrate, but not milk products, as the control diet. Meta-regression analyses further revealed a significantly inverse association between pre-treatment BP and the level of BP reductions. In conclusion, soya protein intake, compared with a control diet, significantly reduces both SBP and DBP, but the BP reductions are related to pre-treatment BP levels of subjects and the type of control diet used as comparison.

Effect of exercise training on vascular endothelial function in patients with stable coronary artery disease: a randomized controlled trial

Background: We aim to investigate the effect of exercise training on endothelial function and exercise capacity in patients with coronary artery disease.

Methods and results: A randomized, controlled trial was conducted to determine the effects of an 8-week exercise training programme ( n = 32) vs. controls ( n = 32) on brachial flow-mediated dilation (FMD) in patients with stable CAD. After 8 weeks, patients received exercise training had significant improvements in FMD (1.84%, p = 0.002) and exercise capacity (2.04 metabolic equivalents, p < 0.001) compared with controls. The change in FMD correlated inversely with baseline FMD ( r = −0.41, p = 0.001) and positively with the increase in exercise capacity ( r = 0.35, p = 0.005). After adjusting for confounders, every 1 metabolic equivalent increase in exercise capacity was associated with 0.55% increase in FMD. Furthermore, patients received exercise training had significantly increased high-density lipoprotein cholesterol and decreased diastolic blood pressure and resting heart rate compared with controls. However, exercise training did not alter high-sensitivity C-reactive protein, oxidative stress measured as superoxide dismutase and 8-isoprostane, and CD34/KDR + endothelial progenitor cell count. Subgroup analysis showed that FMD was significantly improved only in CAD patients with baseline low exercise capacity (<median value of 7.65 metabolic equivalents, p = 0.004) but not in those with normal exercise capacity.

Conclusion: Exercise training improved FMD and exercise capacity in stable CAD patients independent of the changes in inflammation, oxidative stress, or endothelial progenitor cells. The beneficial effects of exercise training on FMD and exercise capacity are inter-related, and more pronounced in those with baseline impaired exercise capacity.

Effects of soy intake on glycemic control: a meta-analysis of randomized controlled trials

BACKGROUND

Evidence from animal and observational studies has supported the beneficial effects of soy intake on glycemic control, but intervention studies in humans have generated mixed results and have not been systematically examined.

OBJECTIVE

We aimed to quantitatively evaluate the effects of soy intake on measures of glycemic control.

DESIGN

We conducted a structured electronic search of PubMed, EMBASE, the Cochrane Library, and the China National Knowledge Infrastructure (updated to March 2010) databases for randomized controlled trials that described the effectiveness of different soy regimes on measures of glycemic control [homeostatic model assessment of insulin resistance (HOMA-IR) and fasting glucose and insulin, glycated hemoglobin (Hb A(1c)), and 2-h glucose and insulin concentrations]. Data on participants, interventions, outcomes, and potential effect modifiers were extracted independently. Weighted mean effect sizes were calculated for net changes by using fixed-effects or random-effects models. We performed prespecified subgroup analyses to explore the influence of covariates on net changes of fasting glucose and insulin concentrations.

RESULTS

Twenty-four trials with a total of 1518 subjects were included in the meta-analysis. Soy consumption did not significantly affect measures of glycemic control. The mean (95% CI) difference was -0.69 mg/dL (-1.65, 0.27 mg/dL) for fasting glucose concentrations in the fixed-effects model (P = 0.16) and -0.18 mg/dL (-0.70, 0.34 mg/dL) for fasting insulin concentrations in the random-effects model (P = 0.50). Significant heterogeneity was noted in the results of fasting insulin concentrations and HOMA-IR.

CONCLUSIONS

There was not a significant overall effect of soy intake on improvements of fasting glucose and insulin concentrations; however, a favorable change in fasting glucose concentrations was observed in studies that used whole soy foods or a soy diet in the subgroup analysis. Evidence for other glycemic variables such as Hb A(1c) and 2-h postchallenge glucose and insulin concentrations was limited because of the small number of trials.

Rosemary extracts improve flow-mediated dilatation of the brachial artery and plasma PAI-1 activity in healthy young volunteers

Polyphenol antioxidants decrease the risk of atherosclerosis. The study aimed to evaluate prospectively in healthy young participants the effect of oral rosemary extracts (RE), consisting of diphenols, upon endothelial dysfunction (ED), preceding structural atherosclerosis. Nineteen healthy young volunteers were studied prospectively, who received oral RE (77.7 mg) for 21 days, consisting of active substances carnosol (0.97 mg), carnosic (8.60 mg) and rosmarinic acid (10.30 mg). Before and after RE treatment, the study evaluated fasting serum levels of plasminogen-activator-inhibitor-1 (PAI-1), vascular cell adhesion molecule 1 (VCAM-1), inter-cellular adhesion molecule 1 (ICAM-1), superoxide dismutase (SOD), glutathione peroxidase (GPX), fibrinogen, high-sensitivity capsular reactive protein (hs-CRP), tumor-necrosis factor α (TNF-α), the lipid profile and ED, characterized as flow-mediated dilatation (FMD) in the brachial artery of < 4.5%, estimated by ultrasound measurements. After 21 days, any side effects were registered, the mean FMD increased nonsignificantly (6.51 ± 5.96% vs 7.78 ± 4.56%, p = 0.546) and ED decreased significantly (66.6% vs 16.6%, p = 0.040). Among the serum markers, only the mean PAI-1 level decreased significantly (4.25 ± 1.46 U/mL vs 3.0 ± 0.61 U/mL, p = 0.012) after 21-day RE supplementation. It is concluded that oral RE supplementation has the potential to improve serum PAI-1 activity and ED in young and healthy individuals.

Dietary intake of phytoestrogen is associated with increased circulating endothelial progenitor cells in patients with cardiovascular disease

Endogenous estrogen is known to positively influence the level and functionality of endothelial progenitor cells (EPC). However, the effect of phytoestrogen on EPC is unknown. Isoflavone is a major component of phytoestrogen. This study aims to investigate if the intake of isoflavone has any impact on the circulating level of EPC. We studied 102 consecutive patients (mean age: 66.5 ± 9.5 years, 78% male, all female post-menopausal) with cardiovascular disease (atherothrombotic stroke 62%, coronary artery disease 38%). Circulating levels of CD133(+) EPC were determined by flow cytometry. Non-invasive pulse wave velocity (PWV) was measured. Long-term intake of isoflavone was determined by a validated food frequency questionnaire. Isoflavone intake was positively associated with circulating CD133(+) EPC (r = 0.31, p = 0.001). Patients with circulating CD133(+) EPC <10th percentile had significantly lower isoflavone intake than patients with CD133(+)EPC ≥10th percentile (4.6 ± 3.7 mg/day versus 19.3 ± 30.2 mg/day, p < 0.001). A significant overall linear trend of circulating EPC across increasing tertiles of isoflavone intake was observed (p = 0.004). Adjusted for potential confounders, increased isoflavone intake from the 1st to the 3rd tertile independently predicted increased circulating CD133(+) EPC level by 221 cells/µl (95%CI: 71.4 to 369.8, relative increase 160%, p = 0.004). Gender was not a significant factor (p > 0.05). Furthermore, circulating CD133(+) EPC <10th percentile was independently predictive of increased PWV by 261.7 cm/s (95% CI: 37.1 to 486.2, p = 0.024). The study demonstrated that circulating EPC increased by more than one fold in patients with cardiovascular disease who had higher intake of isoflavone, suggesting that isoflavone may confer vascular protection through enhanced endothelial repair.

Increased arterial stiffness in patients with psoriasis is associated with active systemic inflammation

BACKGROUND

Psoriasis is associated with premature atherosclerosis although the underlying mechanism remains unclear.

OBJECTIVES

We sought to investigate the relationship between disease activity and systemic inflammation in patients with psoriasis, and macrovascular and microvascular function.

METHODS

Fifty-two patients with psoriasis (mean ± SD age 44 ± 8 years; 38 men) were compared with 50 age- and sex-matched controls. Baseline demographics and high-sensitivity C-reactive protein (hs-CRP) level were recorded for each subject. Psoriatic disease activity was assessed using the Psoriasis Area and Severity Index (PASI). Arterial stiffness and endothelial function were assessed using brachial to ankle pulse wave velocity (baPWV) and digital hyperaemic response measured using the peripheral arterial tonometry (PAT) index.

RESULTS

Patients with psoriasis had significantly higher hs-CRP (mean ± SD 5·3 ± 5·1 vs. 1·9 ± 1·6 mg L(-1), P < 0·01) and baPWV (mean ± SD 14·5 ± 2·5 vs. 13·2 ± 1·6 m s(-1) , P < 0·01) but not PAT index (mean ± SD 2·06 ± 0·59 vs. 2·10 ± 0·44, P = 0·70) than controls. There was significant correlation of hs-CRP with baPWV (r = 0·51, P < 0·01) and with PASI (r = 0·48, P < 0·01). Multiple linear regression analysis demonstrated that baPWV is independently correlated with age, fasting glucose and hs-CRP (P < 0·05), but does not predict PAT index. Each mg L(-1) increase in hs-CRP accounted for an increase in baPWV of +0·12 m s(-1) (95% confidence interval 0·01-0·22, P = 0·03).

CONCLUSIONS

Young patients with psoriasis have increased arterial stiffness but not microvascular dysfunction compared with healthy controls. More importantly, hs-CRP positively correlated with, and independently predicted, arterial stiffness. This suggests that systemic inflammation in patients with psoriasis is associated with premature atherosclerosis.