Cardiovascular diseases (CVD) such as heart attack and stroke are the number one cause of mortality in North America1-3 and indeed many parts of the world.4-6 According to the World Health Organization (WHO), "By 2010, CVD will be the leading cause of death in developing countries."6 Not everyone who suffers a heart attack or stroke will die; the WHO estimates that worldwide, at least 20 million people survive heart attacks and strokes every year, thus requiring medical care that is very costly.6 Stroke is especially debilitating since it is the leading cause of serious long-term disability.1
Direct costs (e.g., expenses related to hospital stays and drugs) and indirect costs (e.g., long-term disabilities and premature death) incurred as a result of cardiovascular disease are in excess of $360 billion annually in the U.S.1 In Canada, total annual costs attributable to cardiovascular diseases (approximately $20 billion) are higher than those incurred by cancer, injuries, and all other categories.3 Unfortunately, cardiovascular diseases are rarely cured and are merely managed by medical and surgical treatments.3 More often than not, the underlying disease progresses and worsens, such that the burden on the patient, the family, and the health care system accumulates.6 Because of this, the WHO, the Heart and Stroke Foundation of Canada, and The Centers for Disease Control and Prevention (among several other organizations, associations, and coalitions) are promoting a heart disease and stroke prevention strategy.3,6
Much research in the last 15 years has shown that consumption of fruits and vegetables plays a role in preventing the onset and slowing the progression of heart disease and stroke.710 Young vegetarians, who did not eat any meat or fish, have been shown to have a 24% lower risk of dying of ischemic heart disease,11 which is not surprising since plant-based foods are low in saturated fat and cholesterol. However, strong evidence points to the content of polyphenols in plant-based foods and beverages such as tea and wine as being correlated with cardiovascular protection.1214 This chapter will review the literature that demonstrates the efficacy of dietary consumption of pomegranates, rich in flavonoids and other antioxidant phytonutri-ents,15-17 in promoting good cardiovascular health, with an emphasis on stroke.
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