Modest protective effects of isoflavones from a red clover-derived dietary supplement on cardiovascular disease risk factors in perimenopausal women, and evidence of an interaction with apoE genotype in 49-65 year-old women

Data suggest that soy protein, a source of isoflavones, may have favorable effects on cardiovascular risk factors. Women (n = 205), ages 49-65 y, were randomized into this double blind, placebo-controlled trial of 43.5 mg red clover-derived isoflavones/d. A total of 177 women completed the trial. There were no differences between treatments for changes from baseline to 12 mo in total cholesterol, LDL cholesterol, triglycerides, HDL cholesterol, systolic and diastolic blood pressures, fibrinogen, and plasminogen activator inhibitor type 1 (PAI-1) (P [greater than or equal to] 0.1). Interactions between treatment and menopausal status were significant for changes in triglycerides and PAl-1 (P = 0.02 and P = 0.01), and changes were significant among perimenopausal women. In the isoflavone and placebo groups, changes in triglycerides were -0.2 [+ or -] 0.6 and 0.4 [+ or -] 0.6 mmol/L, P = 0.02, and changes in PAl-1 were -3.06 [+ or -] 5.88 and 4.95 + 6.25 IU/L, P = 0.004, respectively. Interactions between apolipoprotein E (apoE) genotype and treatment tended to be significant for changes in total and LDL cholesterol (P = 0.06 and P = 0.05), and differences between treatments were significant in E2/E3 women. In the isoflavone and placebo groups, changes in total cholesterol were -0.61 [+ or -] 0.79 and 0. 18 [+ or -] 0.79 retool/L, P = 0.03, and changes in LDL cholesterol were -0.84 [+ or -] 0.79 and -0.04 [+ or -] 0.69 mmol/L, P = 0.02, respectively. Although there were potentially beneficial changes in triglycerides and PAI-1 among perimenopausal women consuming isoflavones, this study suggests that isoflavones alone are not responsible for the well-documented effects of soy protein on blood lipids. A larger study is required to confirm the effect modification by apoE genotype. KEY WORDS: * isoflavone * phytoestrogen * cardiovascular disease * apoE * randomized controlled trial