According to a recent report of the World Health Organization (WHO) cardiovascular diseases (CVDs) are the number 1 cause of death globally: more people die annually from CVDs than from any other cause. An estimated 17.9 million people died from CVDs in 2016, representing 31% of all global deaths.47

These numbers are constantly increasing. In a recent study, researchers estimated that by 2030, 40.5% of the U.S. population is projected to have some form of cardiovascular disease.46

It has been emphasized by the WHO that most cardiovascular diseases can be prevented by addressing behavioral risk factors such unhealthy diet, obesity, physical inactivity, and harmful use of tobacco, and alcohol. 47

Let’s look at elements of these factors, and how to manage them to support the health of your circulatory system.



Since the suggestions from the 70s, that the abundance of omega 3 fatty acids in the diet of the Greenland Eskimos was responsible for their low mortality from ischaemic heart disease, there has been considerable interest in the protective role and possible mechanism of action of marine unsaturated fats.39, 40

From that time, a great number of studies, including epidemiologic and controlled interventional studies, comprehensive reviews, and meta-analyses found that marine- and plant-derived omega-3 fatty acids have beneficial effects on cardiovascular diseases. Thus omega-3 fatty acid therapy has shown promise as a useful tool in the primary and secondary prevention of CVD.9-40

The European Food Safety Authority (EFSA), which provides scientific advice to assist policy makers, has confirmed that clear health benefits have been established for the dietary intake of omega-3 fatty acids such as:26-29

  • EPA and DHA contribute to the normal function of the heart
  • DHA and EPA contribute to the maintenance of normal blood pressure
  • DHA and EPA contribute to the maintenance of normal blood triglyceride levels
  • ALA contributes to the maintenance of normal blood cholesterol levels

The role of omega-3 fatty acids in the prevention of cardiovascular conditions, however, is not without controversy. A new review, published recently in the Cochrane Library, combining the results of 79 trials involving more than 112,00 people, found taking more long-chain omega 3 fats (including EPA and DHA) probably makes little or no difference to risk of cardiovascular events, coronary heart deaths, coronary heart disease events, stroke or heart irregularities.8

So, what is the real story about the protective role of omega-3s?

The most important thing that should be understood is that, despite the widespread use of omega-3 supplements, the major part of the world population does not meet the minimal dietary recommendations for omega-3 fatty acids EPA and DHA. So it is not just about the health benefits of an increased level of EPA and DHA. It is about providing enough so that you are not deficient.

A comprehensive review, that included 266 individual surveys, representing 113 countries and 82% of the global population, found that only 18.9% of the surveyed population met optimal intake for seafood omega-3 fats (EPA+DHA≥250 mg/day).42

It has been noted that blood levels of EPA + DHA are more reliable indicators of deficiency than simple assessments of dietary intake. While global mapping of blood EPA + DHA levels found variability across the globe, most countries and regions of the world had levels that are consideredlow to very low.45 Reliable observational studies have indicated that these low levels are associated with an increased risk in cardiovascular related mortality.41-45

The Cochrane Review indicated some limitations to the studies. It noted that the physiological effects of long-chain omega-3 fatty acids (DHA and EPA) are only seen clearly at higher intake levels, usually in excess of 3 grams per day This is much higher than the amounts used in the trials, which was typically no more than 1grams per day.48

In fact, the European Food Safety Authority, in its review about authorized health claims for foods and supplements, tsaid that to obtain a beneficial effect for disease prevention, such as the maintenance of normal blood pressure or the maintenance of normal triglyceride levels, a daily intake of 2, or 3 grams, but no more than 5 grams of EPA and DHA is needed.27-29

Finally, even the Cochrane Review emphasized that EPA and DHA have been found to slightly reduce serum triglycerides, and raise HDL (high density lipoproteins) > Both of these factors have important roles in the prevention of CVDs.

So don’t neglect the positive effects of Omega 3 supplements, particularly those containing DHA & EPA.



Adequate consumption of vegetables and fruit are vitally important to healthy functioning of the cardiovascular system as both sources of nutrients, and non-nutritive food constituents (eg: fiber).

A review published in the International Journal of Epidemiology, that includes the results of 95 separate studies, found that there was a 16% reduction in the risk of heart disease, a 28% reduction in the risk of stroke and a 22% reduction in the risk of cardiovascular disease for an intake of 500 g of fruits and vegetables per day, compared to 0–40 grams per day.6 Moreover, for heart disease, stroke, cardiovascular disease and all-cause mortality, the lowest risk was observed at 800 grams/day (10 servings/day). 6

Statistics show that average daily consumption of vegetables and fruit is far below the recommended daily amount.1-5 National nutrition surveys showed that in the UK only 1 in 3 adults, or 1 in 10 adults in the U.S.A. meet the official fruit or vegetable recommendations. 4, 5


The World Health Organization (WHO) recommends eating at least five 80 g portions of fruit and vegetables every day (total 400 grams per day). This should be considered as a minimum amount. It should be noted that in the WHO recommendation, potatoes, sweet potatoes, cassava and other starchy roots are not classified as vegetables, and not included in the “400 grams per day” limit.7



Physical inactivity has been identified as the fourth leading risk factor for global mortality, and one of the main preventable risk factors for cardiovascular disease. According to the WHO fact sheet on physical activity, people who are insufficiently active have a 20% to 30% increased risk of death compared to people who are sufficiently active.49-57

According to the WHO, in order to improve cardiorespiratory and muscular fitness, bone health and reduce the risk of non-communicable diseases and depression, the following are the minimum recommended for adults:57

  • 150 minutes of moderate-intensity aerobic physical activity throughout the week, or
  • 75 minutes of vigorous-intensity aerobic physical activity throughout the week, or
  • an equivalent combination of moderate- and vigorous-intensity activity.

For additional health benefits, adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity activity. Muscle-strengthening activities should be done involving major muscle groups on two or more days a week. 57


In addition to healthy diet and regular physical activity, natural products and nutraceuticals are increasingly researched and used to enhance health and prevent chronic diseases. One considered to have significant cardiovascular protective effects is coenzyme Q10 (CoQ10).61

Coenzyme Q10 a fat-soluble compound found in virtually all cells of the body. CoQ10 is involved in mitochondrial energy production, needed for the conversion of energy from carbohydrates and fats to ATP (the form of energy used by cells).

In addition, beside vitamin E, coenzyme Q10 is the principal fat-soluble antioxidant in our body preserving membrane integrity, and protecting lipoproteins (which transport cholesterol and triglycerides through the bloodstream) from oxidative damage.

CoQ10 is synthesized by the body and can be obtained from the diet. In the developed world, the estimated daily CoQ10 consumption is 3–6 mg per day, derived mainly from meat.

According to cardiovascular health related publications, CoQ10 has three main functions: 58

  • a key role in the biochemical process supplying cardiac cells with energy;
  • a role as a cell membrane protecting antioxidant;
  • a direct effect on genes involved in inflammation and lipid metabolism.

Deficiency in CoQ10 could lead to mitochondrial and vascular endothelial dysfunctions resulting in cardiovascular and metabolic diseases.61, 74 Patients who have lower serum CoQ10 concentrations have poorer prognosis from CHF, and those on long term cholesterol-lowering statin therapy may have a decrease of plasma CoQ10 concentrations.61, 74

CoQ10 has been shown to have beneficial effects in patients with coronary artery disease (CAD), chronic heart failure (CHF), hypertension, as well as neuromuscular and neurodegenerative disorders, and migraine.59-74

Although some CoQ10 is obtained from the diet, most is manufactured within the liver, the capacity of which declines with age.58 Tissue concentrations of coenzyme Q10 have been found to decline with age, thereby accompanying age-related declines in energy metabolism.74

In a controlled trial from University Hospital of Linköping, daily supplementation of 200mg of CoQ10, in combination of selenium, for four years exerted a significant improvement in vitality, physical performance, and quality of life in elderly individuals (>70 years).75

In a 12-year follow-up study, significantly reduced cardiovascular mortality has been reported in those supplemented with 200mg of CoQ10 and 200 mcg of selenium, with a cardiovascular mortality of 28.1% in the supplemented group, and 38.7% in the placebo group.76

Researchers concluded, that CoQ10 may have significant potential for cardiovascular prevention as a standalone nutritional supplement and as an adjunct to complement the therapeutic effect of traditional cardiovascular medicines.59, 60,61


Sources ▼