Association of equol producing status with aortic calcification in middle-aged Japanese men: The ERA JUMP study

Xiao Zhang, Akira Fujiyoshi, Vasudha Ahuja, Abhishek Vishnu, Emma Barinas-Mitchell, Aya Kadota, Katsuyuki Miura, Daniel Edmundowicz, Hirotsugu Ueshima, Akira Sekikawa

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Equol, an isoflavone (ISF)-derived metabolite by the gut microbiome in certain individuals termed as equol-producers, might be the key anti-atherogenic component of ISFs. Our objective was to determine the association between equol-producing status and aortic atherosclerosis assessed as aortic calcification (AC). Methods: This population-based study of 302 Japanese men aged 40–49, free of cardiovascular disease, examined serum levels of equol and ISFs, AC in the entire aorta by electron-beam computed tomography with Agatston method, and cardiovascular risk factors. We defined equol-producers as individuals with serum levels of equol ≥20 nM and prevalent AC as an AC score ≥ 10. We analyzed the association between equol-producing status and AC using Tobit and logistic regressions. We performed age-stratified analyses since age was a significant effect-modifier. Results: The 70th to 90th percentile AC scores were 4 to 243 in equol-producers and 15 to 444 in non-producers, respectively. Overall, equol-producers (41% of the sample) had lower AC scores (−209, [95% confidence interval (CI): −455, 36]) and odds of AC (odds ratio (OR): 0.7 [95% CI: 0.4, 1.3]), although not statistically significant, compared to non-producers after controlling for cardiovascular risk factors. Among men aged 46–49, equol-producers had significantly lower AC scores (−428 [95% CI: −827, −29]). Furthermore, there were null associations between serum levels of ISFs and both AC score and the odds of AC. Conclusion: In middle-aged Japanese men, equol-producers had a non-significantly lower burden of aortic atherosclerosis than non-producers whereas ISFs had a null association. Studies with larger sample sizes in both sexes are warranted.

Original languageEnglish
Pages (from-to)158-164
Number of pages7
JournalInternational Journal of Cardiology
StatePublished - 1 Apr 2022
Externally publishedYes


  • Aortic calcification
  • Atherosclerosis
  • Epidemiology
  • Equol
  • Japanese
  • Soy isoflavones


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