title: A review of the use of bromelain in cardiovascular diseases.
abstract: BACKGROUND
  In 2004 an estimated 17.1 million people died from cardiovascular diseases (CVDs) worldwide, representing 29% of all global deaths. According to the American Heart Association, heart disease and stroke are the main cause of death and disability among people with type 2 diabetes. Additional safe and effective approaches are needed for the prevention and management of CVDs which may include nutritional supplements.
  
  
  OBJECTIVE
  To identify the potential of bromelain (a food supplement) on the risk factors associated with CVDs.
  
  
  METHODS
  An electronic and manual search was conducted during November 2009 to March 2010. The databases searched included: Ovid MEDLINE; All EBM Reviews-Cochrane Database of Systematic Reviews (Cochrane DSR), American College of Physicians (ACP) Journal Club, Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials (CCTR), Cochrane Methodology Register (CMR), Health Technology Assessment (HTA) and National Health Service Economic Evaluation Database (NHSEED); Allied and Complementary Medicine (AMED); British Nursing Index and Archive; EMBASE; Health Management Information Consortium (HMIC); Science Direct and Electronic Thesis Online Services (ETHOS). Only papers in the English language were included.
  
  
  METHODS
  Randomised controlled trials (RCTs), human studies, animal studies and experimental studies related to bromelain for CVDs.
  
  
  METHODS
  The quality assessment of all the selected studies was conducted by the authors. Data from 3 animal trials and 3 human trials were included in the review. Data collected included: type of trial, drug dosage, duration, outcome measures, characteristics of bromelain used, significance of results and conclusion.
  
  
  RESULTS
  Out of 223 papers retrieved, 6 papers met the inclusion criteria and could be included in the review. These comprised of 3 animal and 3 human trials, each of which investigated the use of bromelain for CVDs. Results suggested that bromelain could be used for treating acute thrombophlebitis, as it decreases aggregation of blood platelets, has a cardio-protective effect, ameliorates rejection-induced arterial wall remodelling, prevents thrombin-induced human platelet aggregation as well as reduces thrombus formation.
  
  
  CONCLUSIONS
  No substantive study of bromelain and clinical CVDs has been carried out in human populations. Only a few studies on bromelain and CVDs were published from 1948 to 2010. This may be an area worthy to be explored in future CVDs research.
authors.affiliation: Social Care and Human Sciences, School of Psychology, University of West London, Middlesex, TW8 9GA, UK.
authors.forename: Chit Moy
authors.initials: CM
authors.lastname: Ley
authors.forename: Amalia
authors.initials: A
authors.lastname: Tsiami
authors.forename: Qing
authors.initials: Q
authors.lastname: Ni
authors.forename: Nicola
authors.initials: N
authors.lastname: Robinson
mesh_terms: D000818:Animals; D001963:Bromelains / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000517:prevention & control* / Q000628:therapy*; D006801:Humans
chemical_list: D001963:Bromelains