**11. Cardiovascular health, menaquinones, and fermented dairy products**

Coronary artery calcification (CAC) is a predictor of cardiovascular disease (CVD) and mortality. Based on vitamin K's role in activating matrix Gla protein (MGP), a calcification inhibitor, vitamin K is proposed to play a preventive role in CAC and CVD [59, 62]. As recently reviewed, randomized controlled trials that examined the influence of vitamin K on the risk of cardiovascular disease are scarce [63]. The results of observational studies have shown an association between higher dietary menaquinone consumption and less calcification [64], decreased risk of coronary heart disease (CHD), CHD mortality, and all‐cause mortality [65– 67]. The results of a Dutch prospective cohort study suggested that of all MKs the long‐chain menaquinones (MK‐7 to MK‐9) have the most beneficial effects on cardiovascular disease [67]. Although these results are promising, they must be interpreted with caution, because validated biomarkers for single MK intake are missing [16].

Complex milk fatty acid chemistry and several minerals, such as calcium, magnesium, phosphorus, and potassium provided in relevant concentrations, have been proposed to be involved in the complex mechanism of dairy products and their support to reduce CVD risk [68]. Among the high number of different fatty acids in dairy products, trans‐palmitoleic acid, stearic acid, lauric acid, myristic acid, and oleic acid have been associated with beneficial effects on blood lipids and serum lipoprotein levels [56]. These assumptions are supported by the inverse association observed between CHD risk and the consumption of milk, cheese, and meat as the richest sources of MKs in the Western diet [6, 67].
