Association of Soy Intake with Cardiovascular Outcomes and All-Cause Mortality in Chinese Population: Results from a National Wide Prospective Cohort Study

Background: Whether soy products confer health benefits related to cardiovascular disease (CVD) and all-cause mortality remains unclear because of inconsistent evidence. Methods: We conducted a population based, prospective cohort study among Chinese population. A total of 97 930 participants aged ≥ 40 years who had no cardiovascular disease at baseline were enrolled between 2011-2012. Habitual soy intake in the preceding 12 months was evaluated via a food frequency questionnaire. Follow up visit was conducted during 2014-2016 to assess incident CVD and all-cause mortality. Results: During 350 604 person-years of follow-up, 2523 incident total CVD events and 1473 incident all-cause mortality, were documented. The Kaplan-Meier curves illustrated that participants with higher daily soy consumption had a decreased cumulative incidence of total CVD events (P=0.0445) and all-cause mortality (P=0.0053). After control for covariates, the hazard ratios (HRs) (95% CIs) for total CVD events across increasing soy intake were 1.02 (0.92-1.14), 0.96 (0.85-1.07), and 0.85 (0.74-0.98; P trend =0.0397), and the HRs (95%CIs) for all-cause mortality across increasing soy intake were 0.88 (0.77-1.02), 0.86 (0.74-1.00), and 0.83 (0.69-0.99; P trend =0.0083) among general population. For all-cause mortality, the adverse association seemed to be nonexistent among those with current smoking (P interaction =0.0523). No inverse association was observed between soy intake with non-fatal stroke, non-fatal myocardial infarction, hospitalized or treated heart failure, and CVD death among general population. Conclusion: High soy intake seems to be associated with a lower risk of total CVD events and all-cause mortality among Chinese population. Funding Statement: The research reported in this publication was supported by the Ministry of Science and Technology of the People’s Republic of China (award nos. 2016YFC1305600, 2016YFC1305202, 2016YFC1304904, 2017YFC1310700, 2018YFC1311705, 2018YFC1311800), the Chinese Medical Association Foundation and Chinese Endocrine Society (12020240314), and the National Key New Drug Creation and Manufacturing Program of Ministry of Science and Technology (2012ZX09303006-001). Declaration of Interests: None. Ethics Approval Statement: The study was approved by the Medical Ethics Committee of Ruijin Hospital, Shanghai Jiaotong University. All participants signed the written informed consent.