AHA Does Not Recommend Isoflavone Supplements

From: Subject: AHA Does Not Recommend Isoflavone Supplements Date: Mon, 15 May 2006 17:37:09 +0200 MIME-Version: 1.0 Content-Type: multipart/related; type="text/html"; boundary="----=_NextPart_000_0041_01C67846.3114AC00" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.2869 This is a multi-part message in MIME format. ------=_NextPart_000_0041_01C67846.3114AC00 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.medscape.com/viewarticle/522256_print AHA Does Not Recommend Isoflavone Supplements

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3D"Medscape

American Heart Association Does Not Recommend = Isoflavone=20 Supplements CME/CE

News Author: Laurie Barclay, MD
CME Author: Charles = Vega, MD,=20 FAAFP

Complete author affilia= tions and=20 disclosures, and other CME information, are available at the end of = this=20 activity.

Release Date: January 25, 2006; Valid for credit through January 25, 2007=20

Credits Available

Physicians - up to 0.25 AMA PRA = Category 1=20 continuing medical education credits for physicians ;
Family=20 Physicians - up to 0.25 AAFP Prescribed continuing medical education = credits=20 for physicians ;
Nurses - up to 0.3 ANCC continuing education = contact=20 hours for nurses (0.0 credits are in the area of pharmacology)

All other healthcare professionals completing continuing education = credit for=20 this activity will be issued a certificate of = participation.
Participants=20 should claim only the number of hours actually spent in completing the=20 educational activity.

Jan. 25, 2006 =97The American Heart Association (AHA) nutrition = committee found=20 a lack of benefit from soy and therefore does not recommend isoflavone=20 supplements in food or pills, according to a report in the January 17 = Rapid=20 Access issue of Circulation.

"Soy protein and isoflavones (phytoestrogens) have gained = considerable=20 attention for their potential role in improving risk factors for = cardiovascular=20 disease," write Frank M. Sacks, MD, and colleagues from the AHA = Nutrition=20 Committee. "This scientific advisory assesses the more recent work = published on=20 soy protein and its component isoflavones."

In most of 22 randomized trials reviewed, isolated soy protein with=20 isoflavones, as compared with milk or other proteins, decreased = low-density=20 lipoprotein (LDL) cholesterol concentrations by an average amount of = about only=20 3%. This reduction was small relative to the large amount of soy protein = tested=20 in these studies, which was about 50 g, or half the usual total daily = protein=20 intake. There were no significant effects on high-density lipoprotein = (HDL)=20 cholesterol, triglycerides, lipoprotein(a), or blood pressure.

In 19 studies of soy isoflavones, there was no effect on LDL = cholesterol or=20 on other lipid risk factors. The panel also noted no demonstrated = benefit on=20 vasomotor symptoms of menopause, and mixed results in terms of slowing=20 postmenopausal bone loss. Similarly, the efficacy and safety of soy = isoflavones=20 for prevention or treatment of cancer of the breast, endometrium, and = prostate=20 are undetermined, and evidence from clinical trials is limited but = suggests a=20 possible adverse effect.

"For this reason, use of isoflavone supplements in food or pills is = not=20 recommended," the authors write. "Thus, earlier research indicating that = soy=20 protein has clinically important favorable effects as compared with = other=20 proteins has not been confirmed. In contrast, many soy products should = be=20 beneficial to cardiovascular and overall health because of their high = content of=20 polyunsaturated fats, fiber, vitamins, and minerals and low content of = saturated=20 fat."

Circulation. Posted online January 17, 2006.

Learning Objectives for This Educational Activity

Upon = completion of=20 this activity, participants will be able to:=20

Describe the 1999 US Food and Drug Administration (FDA) = recommendations=20 regarding soy consumption.=20
Specify any beneficial health effects of soy protein or soy = isoflavone=20 consumption.

Clinical Context

In 1999, the US FDA approved labeling of soy protein as protective = against=20 coronary heart disease. The authors of the current advisory review the = FDA's=20 statement. The decision to support the health effects of soy was based = on data=20 that at least 25 g/day of soy protein had been demonstrated to reduce = total and=20 LDL cholesterol, and the recommendation assumed intake of 6.25 of soy = protein=20 per serving 4 times daily would satisfy this requirement. This same = announcement=20 noted that soy isoflavones were not critical for the = cholesterol-lowering=20 effects of soy protein.

There has been a considerable amount of research into the health = effects of=20 both soy protein and isoflavones since the FDA report. The authors of = the=20 current Scientific Advisory summarize this research and make = recommendations=20 regarding the use of soy.

Study Highlights

The authors reviewed 22 randomized trials comparing consumption of = isolated soy proteins with other proteins. The range of soy = consumption was 25=20 to 135 g/day. Only 6 of these trials demonstrated a significant = reduction in=20 LDL cholesterol associated with soy protein intake, with a cumulative=20 reduction of only approximately 3% vs control groups. There was no = apparent=20 dose effect of soy protein. The authors of the current advisory note = that=20 intake of 50 g/day of soy protein would account for at least half of = all=20 average daily protein intake for Americans, a ratio that might be = difficult to=20 achieve. Soy protein tended to reduce triglyceride levels by a mean of = 5% and=20 raise HDL cholesterol levels by 1.5%, but these values fail to achieve = overall=20 statistical significance. Soy proteins also had no significant effect = on=20 lipoprotein(a).=20
Soy protein without isoflavones generally reduced LDL cholesterol = to an=20 even lower degree than whole soy protein.=20
Isoflavones given alone had negligible effects on cholesterol.=20
While one study suggested that patients with higher degrees of=20 hypercholesterolemia might derive greater benefit from soy protein, = this was=20 not borne out in another trial. The overall cholesterol content of = diet does=20 not significantly alter soy protein's effects on serum cholesterol.=20
Soy protein lowered blood pressure in only 1 of 6 studies = examining this=20 variable.=20
A minority of trials have demonstrated that soy protein or = isoflavones can=20 improve the vasomotor symptoms of menopause for longer than 6 weeks, = and=20 studies following women for 24 weeks and 2 years have demonstrated no = benefit=20 of soy.=20
Results of research as to whether soy isoflavones can reduce=20 postmenopausal bone loss have been inconclusive. These studies have = examined=20 either bone density studies or biochemical markers of bone turnover, = and=20 inconsistent results should prompt further investigations into this = issue.=20
Soy isoflavones have been hypothesized to reduce the risk for = breast and=20 endometrial cancer through reducing the effects of endogenous = estrogens. Some=20 epidemiologic studies have demonstrated a protective effect of soy = isoflavones=20 against breast cancer, whereas other studies have failed to = demonstrate a=20 benefit. While some research has suggested that increased consumption = of soy=20 isoflavones during adolescence can reduce the later risk for breast = cancer,=20 isoflavones can also stimulate breast epithelial cell proliferation in = premenopausal women, which is a potential precancerous condition. = Overall,=20 there is insufficient evidence to recommend soy isoflavones as a means = to=20 prevent breast cancer.=20
There is less evidence for the efficacy of soy isoflavones in the=20 prevention of endometrial cancer. However, one placebo-controlled = trial=20 demonstrated that soy isoflavones can increase the rate of endometrial = hyperplasia in postmenopausal women.=20
There is insufficient evidence to recommend soy isoflavones in the = prevention of prostate cancer.=20
Because of the lack of significant benefit to health outcomes, the = authors=20 recommend against the use of isoflavone supplements. However, they do = advocate=20 consumption of foods containing soy, as these foods generally have = high=20 contents of polyunsaturated fats, fiber, and vitamins.

Pearls for Practice

Soy protein, but not soy isoflavones, was recommended by the US = FDA in=20 1999 for their ability to lower total and LDL cholesterol.=20
Soy protein and, particularly, soy isoflavones do not appear to = confer=20 significant health benefits, but foods containing soy are recommended = because=20 of their high contents of polyunsaturated fats, fiber, and vitamins. =

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This=20 activity is designed to be completed within the time designated on the = title=20 page; physicians should claim only those credits that reflect the time = actually=20 spent in the activity. To successfully earn credit, participants must = complete=20 the activity online during the valid credit period that is noted on the = title=20 page.

FOLLOW THESE STEPS TO EARN CME/CE CREDIT*:=20

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Target Audience

This article is intended for primary care clinicians, cardiologists,=20 obstetrician-gynecologists, oncologists, and other specialists who care = for=20 patients who use soy to improve health outcomes.

Goal

The goal of this activity is to provide medical news to primary care=20 clinicians and other healthcare professionals in order to enhance = patient=20 care.

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For Physicians

Medscape is accredited by the Accreditation Council for Continuing = Medical=20 Education (ACCME) to provide continuing medical education for = physicians.

Medscape designates this educational activity for 0.25 Category 1=20 credit(s) toward the AMA Physician's Recognition Award. Each = physician=20 should claim only those credits that reflect the time he/she actually = spent in=20 the activity.

Medscape Medical News (MMN) has been reviewed and = is=20 acceptable for up to 150 Prescribed credits by the American Academy of = Family=20 Physicians. AAFP accreditation begins 09/01/05. Term of approval is for = 1 year=20 from this date. This component is approved for 0.25 Prescribed credit. = Credit=20 may be claimed for 1 year from the date of this issue.

Contact This Provider

For=20 questions regarding the content of this activity, contact the accredited = provider for this CME/CE activity: mailto:CME@webmd.net For technical = assistance,=20 contact CME@webmd.net.

For Nurses

This Activity is sponsored by Medscape Continuing Education Provider = Unit,=20 which has been approved as a provider of continuing education by the New = York=20 State Nurses Association, an accredited approver by the American Nurses=20 Credentialing Center's Commission on Accreditation.

Approved for 0.3 contact hour(s) of continuing education for RNs, = LPNs, LVNs=20 and NPs; 0.0 credits are in the area of pharmacology.

Provider = Number:=20 6FDKKC-PRV-05

Authors and Disclosures

As an organization accredited by the ACCME, Medscape requires = everyone who is=20 in a position to control the content of an education activity to = disclose all=20 relevant financial relationships with any commercial interest. The ACCME = defines=20 "relevant financial relationships" as financial relationships in any = amount,=20 occurring within the past 12 months, including financial relationships = of a=20 spouse or life partner, that could create a conflict of interest.

Medscape encourages Authors to identify investigational products or = off-label=20 uses of products regulated by the US Food and Drug Administration, at = first=20 mention and where appropriate in the content.

News Author

Laurie Barclay, MD
is a freelance writer for Medscape.

Disclosure: Laurie Barclay, MD, has disclosed no relevant financial = relationships.

Clinical Reviewer

Gary Vogin, MD
Senior Medical Editor, Medscape

Disclosure: Gary Vogin, MD, has disclosed no relevant financial=20 relationships.

CME Author

Charles P Vega, MD
Associate Professor, Residency = Director,=20 Department of Family Medicine, University of California, Irvine

Disclosure: Charles Vega, MD, FAAFP, has disclosed that he has = received=20 grants for educational activities from Pfizer.

About News CME

News CME is designed to keep physicians and other = healthcare=20 professionals abreast of current research and related clinical = developments that=20 are likely to affect practice, as reported by the Medscape Medical News = group.=20 Send comments or questions about this program to mailto:%20cmenews@medscape.net.

Medscape Medical News 2006. =A9 2006 Medscape

Legal Disclaimer

The material presented here does not necessarily = reflect the=20 views of Medscape or companies that support educational programming on=20 www.medscape.com. These materials may discuss therapeutic products that = have not=20 been approved by the US Food and Drug Administration and off-label uses = of=20 approved products. A qualified healthcare professional should be = consulted=20 before using any therapeutic product discussed. Readers should verify = all=20 information and data before treating patients or employing any therapies = described in this educational activity.

Registration for CME credit and the post test must be completed=20 online.
To access the activity Post Test, please go to:
http://www.medscape.c= om/viewarticle/522256

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