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Effects of dietary soy containing phytoestrogens on lipids, coagulation and fibrinolysis
Heart,
Lung
and Circulation
Selected
2003; 12
decreases from 8.8 to 7.5 days between 1993/94 and 1998/99. In hospital mortality also decreases from 10.4 to 9.8% (P < 0.001) for males and 17.5-16.6% (P < 0.001) for females aged t 40. In 1998/99 the mortality rate for patients aged 2 40 undergoing CC, PCR or CABG is 2.7% compared with 12.1% for the whole AM1 population aged t 40. Conclusion The use of CC and intervention procedures has significantly increased in the last decade. Males are more likely to undergo intervention as are patients aged 40-64 years. Hospital mortality rates have improved however, the mortality rate is significantly higher in women. Key words: Angiography, Angioplasty, Cardiac surgery, Myocardial infarction. treatment Turning Dietary Policy into Dietary Practice - Assessment of a Dietary Model to Improve Eating Patterns David Colauhounl, Susan Andersor?, Phillip Barter3 ‘Wesley Medical Centre, Australia; 2National Heart Foundation of Australia, Australia; 3Flinders University, Australia Background It is ideal for dietary advice to be based on the best available evidence to influence clinical practice and result in improved health outcomes. Uptake of Heart Foundation (HF) recommendations for dietary fat has been less than optimal. The HF policy emphasises a ratio of polyunsaturated fats (PUFA) to saturated fats (SAFA) of > 1. Only 1% of Australian adults meets these recommendations. The aim of this study was to develop food based dietary recommendations that would ensure that the HF policy on dietary fat was more effectively adopted. Methods Analysis of dietary fat intakes and food sources from the latest nutrition survey was conducted. Computer simulations compared the effectiveness of fat modification and fat reduction strategies. A Diet Model was developed based on Australian eating patterns, HF dietary fat policy and the Australian dietary guidelines. Manipulations of the Diet Model tested the effect of specific food choices and their frequency of consumption. Behavioural research identified relevant lifestyle factors and attitudes that influence the adoption of dietary fat behaviours. Results The Australian diet has a PUFA:SAFA inconsistent with HF policy of 0.4. Fat modification strategies targeting major sources of SAFA were more effective than fat reduction strategies in shifting diets towards policy recommendations. Specific food-based recommendations include the daily use of at least 20-25 g of unsaturated spreads, oils and dressings, low fat milk and yoghurt, restrict cheese and icecream to twice a week, include fish twice a week, limit fatty processed meats, snack on nuts and fruit, base meals on vegetables, grain foods and incorporate legumes, limited takeaway foods, snack foods and cakes, pastries and biscuits to each once a week. Conclusion Australians are not complying with policy recommendations on dietary fat. The HF has used an evidence-based approach to develop specific food-based recommendations to ensure more effective uptake of its dietary fat policy. Key words: Fatty acids, Nutrition, Patient care, Prevention Stress Hyperglycemia Reflects Pancreatic Beta-Cell Failure Kris E Park, Keri Chambers, Carol Ting, Steven C Boyages Department Diabetes and Endocrinology, Westmead Hospital, NSW, Australia
Westmead
Background Hyperglycemia is frequently observed in those with an acute illness without prior history of Diabetes mellitus (DM). This is often thought to be a transient and benign condition reflecting acute ‘stress’. We hypothesize that ‘stress hyperglycemia’ reflects the underlying impaired glucose metabolism. Aims: (a) to determine the prevalence of undiagnosed DM and ‘stress hyperglycemia’ in patients with acute coronary syndromes (ACS) and (b) to differentiate impaired glucose metabolism (i.e. persistent hyperglycemia) from ‘stress hyperglycemia’ following hospital discharge. Method Fasting serum glucose (FSG) were measured in consecutive patients admitted to our Coronary Care Unit with ACS over 6-month period. Fasting hyperglycemia was defined as t 5.5 mmol/L. Those who had FSG 2 5.5 mmol/L were retested following hospital discharge. 75 g Oral Glucose Tolerance Test (OGTT) was performed on those with persistent fasting hyperglycemia.
abstracts
from
the XIVth World Congress of Cardiology, May 5-9,2002
A65
Result Excluding known diabetics, 68% (n = 161/237) had fasting serum glucose > 5.5 mmol/L. Additional 3% (n = 7/237) were newly diagnosed DM. Patients with acute myocardial infarction had FSG level 0.7 mmol/L higher than those who presented with unstable angina pectoralis. Of 137 patients initially consented for the study 90 had a follow up FSG levels measured and of these, 45 subjects (50%) still had persistently elevated FSG levels. We have so far performed OGTT on 14 of these subjects and there were 4 additional cases of newly diagnosed DM, 3 cases of impaired glucose tolerance and 1 with impaired fasting hyperglycemia. Conclusion ‘Stress hyperglycemia’ reflects underlying pancreatic beta cell failure in those with clinical vascular disease and a close follow-up is essential to delineate their true state of glucose tolerance upon resolution of an acute stress Key words: Cardiovascular disease prevention, Coronary artery disease, Diabetes mellitus, Risk factors Effects of Dietary Soy Containing Phytoestrogens on Lipids, Coagulation and Fibrinolysis Roger E Peverill’, Helena J Teede2, Barry P McGrath’, Dimitra Kotsopoulos3, Erica Malanl, Joseph J Smolich’, Fabien S Dalais3 ‘Centrefor Heart and Chest Research, Monash University Department of Medicine, Monash Medical Centre, Australia; 2Cardiovascular Research Group, Department ofMedicine, Monash University, Dandenong Hospital, Dandenong, Australia; 3Department of Medicine, Monash University, Dandenong Hospital, Dandenong, Australia Background Soy protein contains phytoestrogens, which have structural similarity to estrogen, and accumulating evidence suggests that soy may have beneficial effects on cardiovascular risk factors. However, while estrogen is also recognised to have adverse effects on coagulation and beneficial effects on fibrinolysis, the effect of soy/phytoestrogens on these processes is unknown. Methods We addressed this question in a randomised double blind, placebo-controlled trial of 42 healthy postmenopausal women of age 50-75 years. Study patients received either soy protein isolate (40 g soy protein, 118 mg isoflavones) or casein placebo and hemostatic factors were measured at baseline and 3 months. Results Baseline levels of lipids and hemostatic factors were similar in the two groups. Comparing change from baseline, there was a significant reduction in LDL cholesterol (- 0.71 f 0.16 vs. - 0.27 f 0.14 mmol/L, P < 0.05), LDL/HDL ratio (- 0.34 f 0.10 vs. 0.18 f 0.09 mmol/L, P < 0.005) and triglycerides (- 0.29 -t 0.09 vs. - 0.01 + 0.10 mmol/L, P < 0.05) in the soy compared to the placebo group. However, there was a trend to an increase in lipoprotein(a) levels with soy (71 & 41 vs. - 45 ? 40 mg/L, P = 0.05). By contrast, there were no differences in the effects of soy and placebo on prothrombin fragment 1 + 2 (- 0.14 f 0.04 vs. - 0.11 ? 0.05 nmol/L), a marker of thrombin generation, soluble fibrin (- 0.22 f 0.46 vs. 0.52 f 0.61 g/mL), a marker of fibrin production, plasminogen activator inhibitor-l (- 0.18 + 0.26 vs. - 0.21 f 0.21 U/mL), a measure of fibrinolytic inhibitory potential or D-dimer (- 9.9 f 8.7 vs. 4.3 + 5.8 ng/mL), a marker of fibrinolysis. Conclusion In healthy postmenopausal women, dietary soy protein containing phytoestrogens has a favourable effect on LDL and triglycerides, an unfavourable effect on lipoprotein(a) but no effect on coagulation or fibrinolysis. Key words: Estrogen, Hemostasis, Lipoproteins Do Left Ventricular Hypertrophy and Systolic Wall Stress Influence the Accuracy for Dobutamine Stress Echocardiography? Satoshi Yuda’, Vincent Khoury*, Peter Cain2, Thomas H Marwick ‘University of Queensland, Department of Medicine, Princess Alexandra Hospital University of @eensland, Australia; 2University of Queensland, Department of Medicine, Princess Alexandra Hospital, Australia Background The effect of LVH on accuracy of dobutamine echo (DbE) has been debated, with previous work suggesting LVH to have no influence on accuracy, and other studies suggesting that concentric remodeling (CR) reduces sensitivity of DbE. We sought to clarify this ambiguity. Methods We studied 195 pts (131 men, age 60 i 11 years) who
Lung
and Circulation
Selected
2003; 12
decreases from 8.8 to 7.5 days between 1993/94 and 1998/99. In hospital mortality also decreases from 10.4 to 9.8% (P < 0.001) for males and 17.5-16.6% (P < 0.001) for females aged t 40. In 1998/99 the mortality rate for patients aged 2 40 undergoing CC, PCR or CABG is 2.7% compared with 12.1% for the whole AM1 population aged t 40. Conclusion The use of CC and intervention procedures has significantly increased in the last decade. Males are more likely to undergo intervention as are patients aged 40-64 years. Hospital mortality rates have improved however, the mortality rate is significantly higher in women. Key words: Angiography, Angioplasty, Cardiac surgery, Myocardial infarction. treatment Turning Dietary Policy into Dietary Practice - Assessment of a Dietary Model to Improve Eating Patterns David Colauhounl, Susan Andersor?, Phillip Barter3 ‘Wesley Medical Centre, Australia; 2National Heart Foundation of Australia, Australia; 3Flinders University, Australia Background It is ideal for dietary advice to be based on the best available evidence to influence clinical practice and result in improved health outcomes. Uptake of Heart Foundation (HF) recommendations for dietary fat has been less than optimal. The HF policy emphasises a ratio of polyunsaturated fats (PUFA) to saturated fats (SAFA) of > 1. Only 1% of Australian adults meets these recommendations. The aim of this study was to develop food based dietary recommendations that would ensure that the HF policy on dietary fat was more effectively adopted. Methods Analysis of dietary fat intakes and food sources from the latest nutrition survey was conducted. Computer simulations compared the effectiveness of fat modification and fat reduction strategies. A Diet Model was developed based on Australian eating patterns, HF dietary fat policy and the Australian dietary guidelines. Manipulations of the Diet Model tested the effect of specific food choices and their frequency of consumption. Behavioural research identified relevant lifestyle factors and attitudes that influence the adoption of dietary fat behaviours. Results The Australian diet has a PUFA:SAFA inconsistent with HF policy of 0.4. Fat modification strategies targeting major sources of SAFA were more effective than fat reduction strategies in shifting diets towards policy recommendations. Specific food-based recommendations include the daily use of at least 20-25 g of unsaturated spreads, oils and dressings, low fat milk and yoghurt, restrict cheese and icecream to twice a week, include fish twice a week, limit fatty processed meats, snack on nuts and fruit, base meals on vegetables, grain foods and incorporate legumes, limited takeaway foods, snack foods and cakes, pastries and biscuits to each once a week. Conclusion Australians are not complying with policy recommendations on dietary fat. The HF has used an evidence-based approach to develop specific food-based recommendations to ensure more effective uptake of its dietary fat policy. Key words: Fatty acids, Nutrition, Patient care, Prevention Stress Hyperglycemia Reflects Pancreatic Beta-Cell Failure Kris E Park, Keri Chambers, Carol Ting, Steven C Boyages Department Diabetes and Endocrinology, Westmead Hospital, NSW, Australia
Westmead
Background Hyperglycemia is frequently observed in those with an acute illness without prior history of Diabetes mellitus (DM). This is often thought to be a transient and benign condition reflecting acute ‘stress’. We hypothesize that ‘stress hyperglycemia’ reflects the underlying impaired glucose metabolism. Aims: (a) to determine the prevalence of undiagnosed DM and ‘stress hyperglycemia’ in patients with acute coronary syndromes (ACS) and (b) to differentiate impaired glucose metabolism (i.e. persistent hyperglycemia) from ‘stress hyperglycemia’ following hospital discharge. Method Fasting serum glucose (FSG) were measured in consecutive patients admitted to our Coronary Care Unit with ACS over 6-month period. Fasting hyperglycemia was defined as t 5.5 mmol/L. Those who had FSG 2 5.5 mmol/L were retested following hospital discharge. 75 g Oral Glucose Tolerance Test (OGTT) was performed on those with persistent fasting hyperglycemia.
abstracts
from
the XIVth World Congress of Cardiology, May 5-9,2002
A65
Result Excluding known diabetics, 68% (n = 161/237) had fasting serum glucose > 5.5 mmol/L. Additional 3% (n = 7/237) were newly diagnosed DM. Patients with acute myocardial infarction had FSG level 0.7 mmol/L higher than those who presented with unstable angina pectoralis. Of 137 patients initially consented for the study 90 had a follow up FSG levels measured and of these, 45 subjects (50%) still had persistently elevated FSG levels. We have so far performed OGTT on 14 of these subjects and there were 4 additional cases of newly diagnosed DM, 3 cases of impaired glucose tolerance and 1 with impaired fasting hyperglycemia. Conclusion ‘Stress hyperglycemia’ reflects underlying pancreatic beta cell failure in those with clinical vascular disease and a close follow-up is essential to delineate their true state of glucose tolerance upon resolution of an acute stress Key words: Cardiovascular disease prevention, Coronary artery disease, Diabetes mellitus, Risk factors Effects of Dietary Soy Containing Phytoestrogens on Lipids, Coagulation and Fibrinolysis Roger E Peverill’, Helena J Teede2, Barry P McGrath’, Dimitra Kotsopoulos3, Erica Malanl, Joseph J Smolich’, Fabien S Dalais3 ‘Centrefor Heart and Chest Research, Monash University Department of Medicine, Monash Medical Centre, Australia; 2Cardiovascular Research Group, Department ofMedicine, Monash University, Dandenong Hospital, Dandenong, Australia; 3Department of Medicine, Monash University, Dandenong Hospital, Dandenong, Australia Background Soy protein contains phytoestrogens, which have structural similarity to estrogen, and accumulating evidence suggests that soy may have beneficial effects on cardiovascular risk factors. However, while estrogen is also recognised to have adverse effects on coagulation and beneficial effects on fibrinolysis, the effect of soy/phytoestrogens on these processes is unknown. Methods We addressed this question in a randomised double blind, placebo-controlled trial of 42 healthy postmenopausal women of age 50-75 years. Study patients received either soy protein isolate (40 g soy protein, 118 mg isoflavones) or casein placebo and hemostatic factors were measured at baseline and 3 months. Results Baseline levels of lipids and hemostatic factors were similar in the two groups. Comparing change from baseline, there was a significant reduction in LDL cholesterol (- 0.71 f 0.16 vs. - 0.27 f 0.14 mmol/L, P < 0.05), LDL/HDL ratio (- 0.34 f 0.10 vs. 0.18 f 0.09 mmol/L, P < 0.005) and triglycerides (- 0.29 -t 0.09 vs. - 0.01 + 0.10 mmol/L, P < 0.05) in the soy compared to the placebo group. However, there was a trend to an increase in lipoprotein(a) levels with soy (71 & 41 vs. - 45 ? 40 mg/L, P = 0.05). By contrast, there were no differences in the effects of soy and placebo on prothrombin fragment 1 + 2 (- 0.14 f 0.04 vs. - 0.11 ? 0.05 nmol/L), a marker of thrombin generation, soluble fibrin (- 0.22 f 0.46 vs. 0.52 f 0.61 g/mL), a marker of fibrin production, plasminogen activator inhibitor-l (- 0.18 + 0.26 vs. - 0.21 f 0.21 U/mL), a measure of fibrinolytic inhibitory potential or D-dimer (- 9.9 f 8.7 vs. 4.3 + 5.8 ng/mL), a marker of fibrinolysis. Conclusion In healthy postmenopausal women, dietary soy protein containing phytoestrogens has a favourable effect on LDL and triglycerides, an unfavourable effect on lipoprotein(a) but no effect on coagulation or fibrinolysis. Key words: Estrogen, Hemostasis, Lipoproteins Do Left Ventricular Hypertrophy and Systolic Wall Stress Influence the Accuracy for Dobutamine Stress Echocardiography? Satoshi Yuda’, Vincent Khoury*, Peter Cain2, Thomas H Marwick ‘University of Queensland, Department of Medicine, Princess Alexandra Hospital University of @eensland, Australia; 2University of Queensland, Department of Medicine, Princess Alexandra Hospital, Australia Background The effect of LVH on accuracy of dobutamine echo (DbE) has been debated, with previous work suggesting LVH to have no influence on accuracy, and other studies suggesting that concentric remodeling (CR) reduces sensitivity of DbE. We sought to clarify this ambiguity. Methods We studied 195 pts (131 men, age 60 i 11 years) who