Risk of Cardiovascular Disease-Related and All-Cause Death According to Serum Concentrations of Enterolactone

Background: Enterolactone is a plant-derived compound that has been associated with a reduced risk of acute coronary events and cancer. Several studies have suggested that serum enterolactone concentration may play a role as a biomarker of a diet high in fiber and vegetables. Owing to its phenolic structure, enterolactone and its plant lignan precursors, which are converted by intestinal bacteria to enterolactone, are potential antioxidants. Methods: The associations between serum enterolactone level and the risk of coronary heart disease (CHD)– related, cardiovascular disease (CVD)–related, and allcause mortality were investigated in the Kuopio Ischaemic Heart Disease Risk Factor Study, which is a prospective population-based study of middle-aged Finnish men. The serum enterolactone concentration and cardiovascular risk factors were determined in 1889 men aged 42 to 60 years. In an average follow-up of 12.2 years, 70 CHDrelated, 103 CVD-related, and 242 all-cause deaths occurred in participants free of prior CVD. Results: Multivariate analyses showed significant associations between elevated serum enterolactone concentration and reduced risk of CHD- and CVD-related mortality, but weaker associations in relation to allcause mortality. In the Cox proportional hazards regression model adjusting for the most potent confounding factors, the risk of CHD-related (P = .03 for trend) and CVD-related (P = .04 for trend) death decreased linearly across quartiles of serum enterolactone concentration. Conclusions: Our data suggest that a high serum enterolactone level is associated with reduced CHD- and CVD-related mortality in middle-aged Finnish men. These results add to the evidence supporting the importance of whole grain foods, fruits, and vegetables in the prevention of premature death from CVD. Arch Intern Med. 2003;163:1099-1104