**10. Cardiovascular health**

Cardiovascular diseases are one of the main causes of death in the world and one of the five main causes of death and disability in most countries. About 2200 Americans every day, or one every 40 seconds, pass away from cardiovascular disease in the United States [74]. Numerous clinical studies, including DART [75], the GISSI Prevenzione trial [76], GISSI-HF [77], have declared that omega 3 supplementation led to a significant cardioprotective effects. Several studies have investigated the cardioprotective effects of flaxseed from different aspects. This includes dietary supplementation with flaxseed and its effects on atherogenesis [78], lipid profile [79], platelet aggregation [80], arrhythmias [81], hypertension [82], and oxidative stress [83]. In a clinical trial on 112 patients with high blood pressure, Toulabi et al. showed that supplementation with 30 grams of flaxseed per day caused a significant decrease in systolic anddiastolic blood pressure [84]. Also, Mahmudiono et al. in a meta-analysis study showed that flaxseed oil supplementation among the patients with metabolic syndrome and related disorders caused a significant reduction in systolic but not diastolic blood pressure [85]. It is unclear how flaxseed lowers blood pressure and how this happens. Weight loss has been advocated as an effective method for treating high blood pressure in overweight and obese people [56]. But according to one study, flaxseed contains peptides that are high in arginine and can lower blood pressure [86]. Furthermore, flaxseed has a high concentration of ALA. It has been extensively evaluated in some studies and shown that ALA can reduce blood pressure and reduce cardiovascular diseases risk [87, 88].

Also, several studies have evaluated the effect of flaxseed on the lipid profile. Hadi et al. in an updated systematic review and dose-response meta-analysis of 62 randomized controlled trials evaluated the effects of flaxseed on lipid profile, and it has been reported that flaxseed supplementation significantly reduced total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C). However, there were not any significant effects on high-density lipoprotein (HDL-C). Also, they found that flaxseed oil had no effect compared with whole flaxseed or lignin [89]. As mentioned, these beneficial dyslipidemia effects are caused by the content of lignan, phenolic, and ALA in flaxseed. By boosting satiety, lowering caloric intake, and decreasing meal transit time, flaxseed's high fiber content protects against dyslipidemia. It also stimulates bile acid excretion and reduces bile acid reabsorption through enhanced fecal excretion of cholesterol. Additionally, fiber affects other metabolic processes, such as fatty acid biosynthesis, lipolysis, and cholesterol synthesis by forming short-chain fatty acids that prevent the formation of liver cholesterol [90].
