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American Journal of Epidemiology Advance Access published online on March 1, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj080
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received March 22, 2005
Accepted October 20, 2005

ORIGINAL CONTRIBUTIONS

Serum Enterolactone Concentration and the Risk of Coronary Heart Disease in a Case-Cohort Study of Finnish Male Smokers

Annamari Kilkkinen 1 *, Iris Erlund 2, Mikko J. Virtanen 1, Georg Alfthan 2, Kari Ariniemi 3, and Jarmo Virtamo 1

1 Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland
2 Department of Health and Functional Capacity, National Public Health Institute, Helsinki, Finland
3 Department for Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland

* To whom correspondence should be addressed.
Annamari Kilkkinen, E-mail: annamari.kilkkinen{at}ktl.fi


  Abstract

The lignan enterolactone produced by the intestinal microflora from dietary precursors has been hypothesized to protect against coronary heart disease. The present study examined the association between serum enterolactone concentration and the risk of coronary heart disease. A prospective case-cohort study was conducted among male smokers randomized to receive a placebo supplement in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (1986-1999). Serum enterolactone concentrations were measured by the gas chromatography-mass spectrometry method in serum collected at trial baseline from 340 men diagnosed with nonfatal myocardial infarction (n = 205) or coronary death (n = 135) during follow-up and from the randomly selected subcohort of 420 subjects. The classic risk factors-adjusted rate ratios for all coronary heart disease events in increasing quintiles of enterolactone were 1.00 (referent), 0.85 (95% confidence interval (CI): 0.51, 1.43), 0.59 (95% CI: 0.35, 1.00), 0.69 (95% CI: 0.40, 1.16), and 0.63 (95% CI: 0.33, 1.11), and the ptrend was 0.07. For the highest versus the lowest quintile of enterolactone, the rate ratios for nonfatal myocardial infarction and coronary death were 0.67 (95% CI: 0.37, 1.23; ptrend = 0.10) and 0.57 (95% CI: 0.26, 1.25; ptrend = 0.18), respectively. In conclusion, only weak support for the association between serum enterolactone concentration and coronary heart disease was found.

Keywords: biological markers; cardiovascular diseases; cohort studies; coronary disease; diet; myocardial infarction; prospective studies; serum.
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