Therapeutic Effect of Barley on Cardiovascular Diseases

Abstract

Barley is a fantastic food option for those with various illnesses as well as for those who want to lead a healthy lifestyle. This cereal is a great source of soluble dietary fiber, particularly beta-glucans, and it also includes vital vitamins and minerals. For its excellent antioxidant activity and as a source of vitamins and minerals, green barley is advised. Depending on phytonutrients such as glucan, phenolics, flavonoid, lignans, tocols, sitosterol, and folic, regular consumption of whole wheat grain and its hydroethanolic extracts decreases the risk of chronic ailments (hyperglycemia, malignancy, overweight, cardiac disease, and so on). Barley and its products in recent years have gained an importance due to its counteractive components, which play potent role against cardiovascular diseases by lowering down the oxidative stress and improving high-density lipoprotein, further lowering down low-density lipoprotein, VLDL ratios further regulating insulin levels, and lowering down the spike in blood glucose levels showing potent antioxidative and cardiovascular functions. Due to their abundance in these nutrients, barley is effective in promoting healthy bodily function. To enjoy all of the advantages of barley, barley grain is a wonderful option.

1. Introduction

Elevated blood pressure, coronary heart disease (CHD), heart failure, and stroke are all examples of cardiovascular disease (CVD), a condition that affects the heart and blood arteries. Elevated blood pressure, coronary heart disease (CHD), heart failure, and stroke are all examples of cardiovascular disease (CVD), a condition that affects the heart and blood arteries. This disease is usually related to fatty deposits, which are buildup inside arteries, and there is chance of blood clots. Strokes and heart attacks are acute events, which are mainly caused by obstruction of blood from going from the heart to brain. Heart muscles and valves are affected by the heart disease; this can also result in arrhythmias. Heart and blood vessel disorders that impact the anatomy and physiology of the circulatory system are referred to as cardiovascular diseases [1]. Hypertension, ischemic heart disease, peripheral vascular disease, stroke, rheumatic heart disease, heart failure, valvular heart disease, and a congenital cardiac condition are the most prevalent forms of CVD [2].

Blood clots or hemorrhages from a brain blood artery can both result in strokes. A total of 811,940 deaths in 2009 were attributable to CVD, making up 32.8% of all fatalities in the country. There are 82 million Americans who suffer from one or more types of CVD. The two types of CVD risk factors are modifiable and non-modifiable. Gender, age, ethnicity, genetics are all considered as non-modifiable factors. On the other hand, smoking, body weight, blood pressure, lipid, lipoprotein levels are all modifiable factors. CVD can be avoided or reduced by adopting health-promoting habits that target the modifiable risk factors. One can reduce their risk of acquiring CVD by engaging in exercise, eating a healthy diet, taking medicine, and quitting smoking [2].

Strong epidemiological data support the idea that CVD occurs more frequently in families. According to Framingham Study, researchers revealed that not less than one parent with CVD quadrupled a person’s 8-year chance of developing the disease in men and raised it by 70% in women. The extra risk was unrelated to other risk variables such as age, body mass index (BMI), diabetes, total/high-density lipoprotein cholesterol (HDL-C) ratio, systolic blood pressure (SBP), antihypertensive therapy, and current smoking status. History of family is considered as medical and health details of members in family. First- and second-degree relatives’ medical and health information is the most useful because it shares bout 50 and 25%, respectively, of our genes. The presence of common genes that may be responsible for polygenic (complex) illnesses, habitats, and gene-environment interactions that may affect risk are all reflected in family history, which acts as a connection between genetics and genomics in clinical practice. Family history (FH) is a stand-alone CVD risk factor that can be possibly used as a screening tool to detect CVD risk, particularly in asymptomatic young adults [2]. Increased plasma cholesterol has been shown to be a significant CVD risk factor. By boosting LDL expression and lowering LDL oxidation, tea and its polyphenols may lower plasma cholesterol levels. Tea may prevent the development of atherosclerosis by lowering antifibrinolysin, eliminating reactive oxygen species, and causing hypolipemia. In general, tea and its polyphenols may be useful nutritional components for the reduction of cancer and cardiovascular disease (CVD) [3].

1.1 Causes

Cardiovascular diseases (CVDs) are becoming more common over the world and are currently regarded as the main cause of death in both emerging and industrialized nations. The prevalence of these diseases has increased and reached alarming levels in recent decades as a result of the quick economic development and increasingly Westernized lifestyle. The well-known causes of CVDs include behavioral risk factors such as a harmful diet (high in fat, salt, and sugar), physical inactivity, injurious alcohol and tobacco use, a high BMI, a high waist-to-hip ratio, and metabolic risk factors such as hyperglycemia, hyperlipidemia, and high blood pressure. Inflammatory rheumatic disorders are linked to an increased risk of cardiovascular disease (CVD) [4]. High blood pressure, also known as hypertension, atherosclerosis or artery blockages, inactivity, obesity, sleep apnea, excessive alcohol consumption, stress, air pollution, chronic obstructive pulmonary disease, radiation therapy, smoking, poor sleep and hygiene, high blood cholesterol, also known as hyperlipidemia, diabetes, a high-fat, high-carbohydrate diet, or other conditions that reduce lung function are all risk factors for CVD [5]. The growth and progression of CVD are also mediated by metals such as lead, cadmium, and arsenic, which are among the top 10 environmental pollutants of concern according to the WHO [6]. Multiple comorbid illnesses are frequently present in cardiovascular disease (CVD) patients, which can complicate treatment decisions, lower mortality, and interact with one another. One of the most significant comorbidities of CVD is chronic obstructive pulmonary disease (COPD), which has considerable effects on individuals with ischemic heart disease, stroke, arrhythmia, and heart failure. Less physical activity is linked to COPD, which causes systemic inflammation and oxidative stress and shares risk factors with CVD such as smoking and age [7].

1.2 Signs and symptoms

It has been established that sleep apnea has a negative effect on health. Among its severe side effects are chest pain, breathlessness, feeling dizzy, faint, swollen limbs, fatigue, weakness, very fast or slow heartbeat, numbness in legs or arms, stress, physically inactive, being obese or overweight [8]. Heartburn, nausea, vomiting, pressure, or squeezing in the chest, pain radiating to the neck, shoulder, back, arm, or jaw, chest discomfort, clamminess, and cold sweats. Commonly in women symptoms, which are seen are as follows: Slight discomfort in the back, chest, arm, neck, or jaw, sudden onset of weakness, shortness of breath, weariness, and a feeling of systemic sickness (without chest pain) as shown in Figure 1 [9].

Figure 1.

Sign and symptoms of CVD.

The relative chance of developing hypercholesterolemia is more in men that in young women; in postmenopausal stage, lipid profile is adverse, with LDL and total cholesterol, which go high by 10–14%, respectively, without any change in high-density lipoproteins. Therefore, in women with a borderline premenopausal profile, postmenopausal reassessment of lipids is crucial to take into account. However, LDL lowering with statins lowers CHD mortality to a comparable degree as in males, even though mean LDL is higher in women over 65 than in males [10].

1.3 Prevalence

The annual rate of cardiovascular death has been calculated to be around 9%. The main cause of death worldwide is cardiovascular disease (CVD). According to estimates, 17.9 million deaths worldwide in 2019 were attributable to CVDs, or 32% of all fatalities. Heart attacks and strokes were to blame for 85% of these deaths. In low- and middle-income nations, almost 75% of CVD fatalities occur. In 2019, CVDs were responsible for 38% of the 17 million premature deaths (before the age of 70) caused by noncommunicable diseases.

By addressing behavioral risk factors such as tobacco use, unhealthy eating and obesity, inactivity, and problematic alcohol consumption, the majority of cardiovascular illnesses can be kept away. Initial diagnosis of cardiovascular disease is crucial in order to start treatment with counseling and medication. Australian population ranged between 1.0 and 2.0%, in Western countries (United Kingdom, Germany, and the United States), it is about 25% [11]. In Pakistan, it was found that genetic predisposition caused the disease in 72.9% of men and 79.9% of females, while 27.02% of males and 20.99% of females had CVD without any family history. In South Asia, ratio of heart disease is 24.2%, and in East Asia, it is 21.3% [12].

The prevalence of CVD was 14.8 (urban) and 9.7% (rural) among Delhi’s urban and rural groups (rural). Overall, death rates are the highest for both men and women in Punjab, Eastern and Northeastern States, and South Indian States, while they are the lowest in Central Indian States [13].

2. Effect of barley on cardiovascular disease

Hordeum vulgare, often known as barley, is a plant in the Poaceae family. It is estimated that barley was initially cultivated from its native relative Hordeum spontaneum roughly 10,000 years ago. There is proof that the Fertile Crescent’s Israel-Jordan region is where barley was initially grown [14] as well as it is been clarified that barley was further domesticated in Tibet. Barley is a perennial herb that comes in both springs and winters varieties. Winter perennials are sown in the fall and need a duration of cold weather until they will bloom. Modern cultivars also include both hulled and hulless variants [15].

One of the oldest cereal crops still being cultivated today is barley. Barley contains dietary fiber, which contributes to many health advantages. Phenolic acid, folate, vitamin E, lignans, phenolic acids, flavonoids, phytosterols are all present in whole grain barley. These phytochemicals have substantial antioxidant, cholesterol-lowering properties, and inhibition of cell growth that may be helpful in reducing the risk of developing specific diseases. Therefore, in barley there is high concentration of phytochemicals as shown in Figure 2. Barley products were permitted by the Food and Drug Administration (FDA) to make the claim that they cut down the chance of developing heart issue [4].

Figure 2

Health benefits of barley.

3. Potential barley-based health products

3.1 Multigrain atta

The amount of soluble and insoluble fiber in wheat atta is increased with the help of hulled barley (flour). This could lower the glycemic load of flatbreads, a dietary staple, which is consumed particularly in northern India [16].

3.2 Multigrain biscuits and bread

The addition of hulless barley may enhance the bread’s and the biscuits’ nutritional benefits. Experimental investigations at ICAR-IIWBR have demonstrated the viability of barley-based biscuits. Similar to that, barley malts could be used to flavor cookies.

3.3 Barley flakes

Breakfast cereals such as flakes can be made from hulled barley; however, flavoring is required to make the cereals more palatable [16].

3.4 Ready-to-eat and drink sattu: traditionally beverage called as sattu is made from barley or gram flour

The Hadiths admonish sattu (finely ground barley) being a nutritional food. Yet another health item named as Talbina is made by mixing milk and honey with the dried barley powder and by adding Sattoo in it. This meal is very beneficial for the sick and the bereaved, and it also provides the patient’s heart a rest and stimulates it.

In accordance with Ibn al-Qayyim, barley-enriched water when boiled to that extent that only it reduces to three quarters is used to quench thirst and leads in treating skin lesions. Hagiwara investigated that barley is enriched with high sodium content, which maintains calcium levels in the blood, further aids in dissolving the deposits of calcium in joints.

3.4.1 Production

In the year of 2016/2017, worldwide production of barley was 145 million metric tons. Due to massive production annually, barley is placed in fourth number after rice, wheat, and corn produce. Mainly those countries that produce barley in massive amount are Russia, Germany, France, Ukraine, Australia, and Canada. An easily grown, widely accepted, and robust crop, it has now been grown in more than 100 countries worldwide. Primarily, it is grown over in warm countries but its varied growth can also be seen in some tropics regions. About 60% of barley crop is utilized for animal feeding purposes, and the remaining percentage is utilized for majorly for brewing purposes. Previously to till today, barley production has seen an increase of about 60% among European countries. This is partly attributable to the development of more productive cultivars with improved disease and pest resistance. Meanwhile, significant improvement in agricultural practices also posed a major development [17].

4. Types

4.1 Barley grass

The grass of barley is regarded as more than just the best nutraceutical having effective properties required for the cell nourishment with detoxifying effects in humans. Barley grass also contains potent functionalized substances, which have a variety of health-promoting properties [5]. It has ability to oppose more than 20 chronic inflammations or ailments, which is due to the presence of gamma aminobutyric acid, flavonols, SODs, potassium-calcium, vitamin, and tryptophan’s modulatory actions in its grass [18]. The World Health Organization daily consumption targets of less salt’s intake (less than 2 g) and improved K consumption (more than 3.5 g) can be achieved with barley grass powder. Barley increased the sterols deposition with the help of LTP2 gene modulation that plays potent effect in environmental stressed reactions of moderating intracellular lipidases transportation [19].

4.2 Barley grains

Among cereal crops, they offer the high practicable index (less glycemic index, higher glucans, and starches), as well as the best antioxidant capabilities. A class of polysaccharides known as soluble fiber glucans can be present in seaweed, barley, oats, morels, and Saccharomyces cerevisiae [20]. Whole barley flour should be consumed regularly on a daily basis to prevent chronic diseases, particularly diabetes, colonic cancer, hypercholesterolemia, hypertension, and gall-bladder stones [21]. Despite the fact that barley grains have contributed significantly to human health outcomes, there are many major ways through which barley can benefit human health by their modulatory mechanisms [21].

5. Chemical composition

Barley is not just a significant feeder, malts, and food crops in several countries throughout the world, as well as the greatest cereal resource of functional component among the most widespread variety of multifunctional cereal crops and is incredibly full of beneficial nutrients. Particularly fiber, phenols, flavones, phytosterol, alkylresorcinols, benzoxazinoids, lignans, tocols, and folic acid, which have antidiabetes, anticancer, antiobesity, preventive cardiovascular disease, antioxidant, antiproliferative, and cholesterol lowering properties. Whole barley grains and its outermost grain layers are densely packed with the beneficial nutrients [22], as beta-glucans (2.41~7.42%) and total tocols (40.9~81.6 μg/g) A lot more there are 64 compounds, out of which 27 among them are anthocyanides, 9 are flavanols, 9 are flavones glycosidase, and 19 are phenolic acids and aldehydones [23]. Among them, green malt is enriched with potent functional components, which showed (79.80%) of antioxidant potential, total phenol content (123.43 mg/100 g), (+)-catechin (70.06 mg/100 g), quercetin (31.78 mg/100 g), 1,2-dihydroxybenzene (38.21 mg/100 g), isorhamnetin (23.44 mg/100 g), and carotenoid (0.181 mg/100 g) [24]. The largest quantity of folate is found in the germ and outermost layers of hulled barley grains (103.3 mg/100 g). Maximum concentrate of calcium is recorded as 12, potassium is above 6, and iron is above 4 in the barley grains [25].

5.1 Β-Glucan

The most prominent class of polysaccharides, which is found in barley, is B-glucan. In hulless wheat grain, -d-glucan has a molar mass of 571.4 kDa and is composed of glucopyranosyl residues (1, 4, and 3), particularly its trisaccharide and tetrasaccharide, which account for 66.6% of the total cellulose subunits. To lower triglyceride levels and hence prevent diabetic condition, high blood pressure, cardiovascular diseases, and metabolic syndromes, B-glucans interact with the synthesis of bile salts and triglycerides in the stomach [26].

5.2 Polyphenols and flavonoids in hull barley

Anti-inflammatory, anticancer, and antioxidative potentials depend on the phenolic acid compound concentration [27]. Most abundantly available phenols in barley are 4-hydroxybenzoic acid (17.6%), isomers of hydroxycinnamic acid (15.2%), and ferulic acids (54.4%). Natural polyphenolic compounds, which are present in largest proportion, are the flavonoids. Class of anthocyanidins is majorly potent for human health related to flavonoids [28].

5.3 Phytosterols

In plants, structure of phytosterol showed similarity with cholesterol. Increased concentration of phytosterolic compounds is present in the outermost layer of grains of barley and ranges between 81.0 mg/100 g and 114.3 mg/100 g, among which β-sitosterol is 46:6 ± 0:1 mg/100 g and campesterol is 17:1 ± 0:2 mg/100 g. Other potent phytosterolic compound concentration includes stigma sterol (3.9 mg/100 g), brassicasterol, δ5-avenasterol, stigmastanol, stigmastadienol, and other minor sterols (δ5- and δ7-avenasterols, δ7-stigmastenol, and stigmastadienol: 8:6 ± 0:1 mg/100 g) [26, 27, 28].

5.4 Tocols

Most prominently fat-soluble antioxidative compound for human health is vitamin E containing eight stereoisomers. Spring barley compounds have increased alpha-tocopherol concentration among its other classes. Alpha-tocopherol concentration in barley is about 0.860–3.15 mg/100 g dry weight. Tocochromanol concentration in barley is 50% in pericarp, >37% in endo-sperm, which is less than 13% in germ layer; around 85% tocotrienols and fat-soluble phenolic compounds in germ layer (80%) were significant than that which is found in peri-carp (20%) [29].

6. Functioning ingredients in barley grass and barley grain against chronic illnesses

β-Glucans can be used as candidates for the medication in the treatment of human chronic diseases (Table 1).

Preventative action against chronic illnesses	Functioning component in grass	Functioning components in grains	References
Anti-hyperglycemic effect	Saponin; fiber calcium; AMPK, polyaminases; gamma alpha amino butyric acid, sodium oxide dismutase.	Beta-glucan; phenols polysaccharidases; tocolic compounds; phytosterolic compounds, resistant starches.	[30]
Lipid lowering effects or anti-obesity	Saponin; α-tocopherols; 2″-O- homovitexin, polysaccharidases	Polysaccharidases, starches, tocolic compounds, dietary fibers, polyphenolic compounds, polysaccharidases, phytosterolic compounds.	[31]
Anti-cancerous	Alkaline, flavonoids, chlorophyll; tricin; sodium oxide dismutase	Beta-glucan, phenolic compounds, arabinoxylanes, phytosterolic compounds, lignanes, resistant starches	[32, 33]
Anti-oxidative effects	Chlorophyll; lutonarin, saponarin; isoorientin, orientin; γ-tocopherol, glutathione; sodium oxide dismutase, flavonoid, (GABA)	Polyphenolics, anthocyanides, tocotrienols, polysaccharidases, (GABA)	[34, 35]
Immunomodulatory effects	Arabinoxylan; polysaccharide, gamma amino butyric acid	Beta-glucans, arabinoxylans	[36, 37]
Cardioprotective effects	potassium, Gamma amino butyric acid	Beta-D-Glucan	[38]
Blood pressure regulatory effect	Saponarin; lutonarin, potassium, calcium; gamma amino butyric acid	Beta-glucans	[39]
Bowel health regulatory effect	Soluble and insoluble fiber	Beta-glucans, soluble and insoluble fiber	[23]
Anti-preventative effect against CVD	Saponin; tryptophans, vitamins (retinol, thymine, tocopherol), sodium oxide dismutase; potassium, calcium; gamma amino butyric acid	Beta-glucans, arabinoxylans, polyphenolic compounds, phytosterolic compounds, lignanes, tocolic compounds, folic acid	[37, 38, 39]

Table 1.

Functioning ingredients in barley grass and barley grain against chronic illnesses.

6.1 Mechanism of action

Gamma amino butyric acid (C₄H₉NO₂) in barley grass improves sleeping disorders, lowers down high blood glucose levels, maintains hypertension, improves immune system function, has a protective role against liver, has a protective effect against depressant, regulates GIT tract function, potent inflammatory effect, shows oxidative effect, lowers down the risk of CVDs and heart, lessens down the risk of atopic dermatitis, and improves cognitive action. Gamma amino butyric acid and signaling pathways of dopamine are associated with sleep regulation [40]. GABA contains very potent intra-islet transient neurotransmitter, which maintains and regulates cell secretory effect from islets and shows potent inflammatory, immune regulator functional capabilities, which prevent diabetic condition and promote regenerative functional capabilities against beta-cell apoptotic lysis. GABA b receptor agonist baclofen (C₁₀H₁₂ClNO₂) affects toll-like receptor 3 and toll-like receptor 4 activity in glial and immunity boosting cells, which plays the key functional capabilities in neuronal-inflammatory ailments of the body [41].

Gamma amino butyric acid has the ability to prevent and cure CVDs, which are linked with platelet GP VI in such as hemorrhage and heart attack; majorly GABA retards activation of platelet, which is upregulated by convulsion, and increases clotting time of blood and the occlusioning times of platelets plugged forming [41].

7. Barley align with dietary guidelines for people with cardiovascular diseases

Barley, which is been considered as low-fat, fiber-enriched, whole-grain foodstuff in accordance with the nutrition recommendation used for the treatment of CVD regulated by the leading health promotion administration:

• The Heart and Stroke Foundation of Canada countersign intaking of food in relation with Food Guide by Canada’s [42], which recommended that consume at least half of grains in the form of whole grains, eat a diversity of whole grains, and choose those whole grains items that are low fat, low sugar, or low salt [42].

• The American Heart Association countersign: consume those foods that are higher in whole grains, and half of grains consumption should come from whole grains. Whole grains are prescribed because it is the part of American Heart Association’s lifestyle management regulations for lowering of both low-density lipoprotein cholesterol and hypertension [43].

• The Academic Curriculum of Nutrio-Dietetics—outlined on the health imputation of fiber—suggesting that, in accordance with CVD, consumption of dietary fiber from whole foods reduces blood pressure, regulates plasma lipids concentration, further reducing markers of inflammation [43].

8. Healthy effects of functional ingredients in barley grains against cardiovascular diseases

Barley beta-glucan has the ability to lower down low-density lipoprotein and highly dense lipoprotein cholesterol alongside retarding gut microbiotas leading to the prevention of cardiovascular diseases. Nutraceutical functions of the barley have been linked with cardio-protection health, which include polyphenols, phytosterol, lignin, tocolic acid, and folic acid [21]. Barley grains showed potent modulatory effect that only after 11–16 hours of their intake, and they maintained blood glucose levels and appetite hormones by their regulatory actions. Their mechanisms include GIT fermentation of indigestible carbohydrates [38]. Studies showed that the barley sprouted extricate, which contains 19.65 mg/g of overall polyphenolic concentration, and lowers down the extracellular cholesterol concentrations in mice to the levels of 24 and 18%, sequentially. Lignans, which are also found in barley, showed potent antioxidative functions when compared with vitamin E functionality, which is linked in lowering the risk factors of CVD [32].

Barley (1–3) Beta-d-glucan maintains and regulates cardio-protective ischemic effect showing 109% rates of survival chance after 30 minutes of having ischemic heart attack, reperfusion injury, lessens down the results of increase in the capillary at the amount of 12% and arterial density of about 18%, further expressing VEGF (88.7%) of hearts in rats [37].

Barley beta-d-glucan naturally activates the expression of manganese superoxide dismutase expression, which is maintained by anti-inflammation, metabolically and stressed-activated transcriptional factors, which are commonly expressed in relation to a commonly stressed condition, leading to the prevention of heart failure. Beta-glucan lowers down coronary artery disease progression, hyperglycemia, and associated heart problems [38].

Tong et al. in the year 2015 proposed that diet-related beta-glucan found in hulled barley lowers down the plasma low-density lipo-protein cholestrolemic condition by initiating the evacuation of fecal triglycerides and maintaining the functioning of 3-OH-3-glutaryl-coenzyme A and cholesteric 7-α-hydroxylase in rats having hypercholesterolemic condition. Barley-enriched bran of 5–10% when added into the diet of these hypercholesterolemic rats improved the levels of lipases, lactate dehydrogenases, enzymes of liver, and creatinine kinases MB [39].

Wang et al. in the year 2016 conducted an analysis to find out the efficacy of B-glucan on cardiovascular ailments and to investigate that the altered composition of microbes is associated with biological activities of beta-glucan for improvement of the risk factors of cardiovascular diseases in mild hypercholesterolemia participants. Individuals received 3°g of increased molar mass (HMW), 3°g of lower molar mass (LMW), 5°g of low-molecular-weight barley β-glucan or wheat and rice for the time extension of 28 days. Results showed that intake of 3 g/day of high-molecular-weight Beta-glucan increases Bacteroidetes, which results in increased production of Prevotella when compared with 5°g low-molecular-weight Beta-glucan and 3°g low-molecular-weight Beta-Glucan, further suggesting that consuming higher-molar-mass β-glucan restricts the gut microbiota profiling, which is further linked with lower levels of risk-associated cardiovascular diseases markers [15].

Bachetti et al. in the year 2015 conducted an analysis, directed to investigate the nutraceuticals and functional possessions of barley-complemented vegetable-based soup and its protective effect against cardiovascular diseases. A total number of 38 participants took part, whose edibles were complemented for around 14°days including 250°g (Daily portion) of ready-to-eat soup being enriched with carotenes mainly (Beta-carotene and lutein), and its outcome was studied on its lipid profile and lipid peroxidation. After 14°days of treatment, blood serum concentrations of carotenes (lutein and Vitamin A precursor) and levels of overall plasma antioxidative capacities were increased. In addition to detection of reduction in lipid levels (total cholesterol and LDL-cholesterol), reduction in triglycerides oxidized markers (oxidized LDL low-density lipoprotein and lipid hydro peroxides) was seen in plasma levels of all the participants. As in terms of glycemic content of barley, it is of low glycmeic nature and does not blunt higher sugar levels. This study concluded that barley-enriched vegetable soup not only lowers down blood sugar level but also improves cardiovascular functions and serves as cardio-protection, further improving plasma lipid levels [44].

Xia et al. in the year 2018 hypothesized that hulled barley-enriched whole grain lowers down hypercholesterolemia, further improving cholesterol levels by regulating bile acid production leading to its storage in peripheral tissues and lowers down the expression of HMG-COA reductase, which leads to increase in the liver expression of AMP-kinase alpha, low-density lipoprotein receptors, liver X receptor, and peroxisome proliferator-activated receptor alpha [25].

9. Conclusion

Barley (Hordeum vulgare L.) is the world’s fourth most significant cereal grain, with the greatest fiber composition, and can be utilized in a variety of industries for a variety of uses. Depending on phytonutrients such as glucan, phenolics, flavonoid, lignans, tocols, sitosterol, and folic, regular consumption of whole wheat grain and its hydroethanolic extracts decrease the risk of chronic ailments (hyperglycemia, malignancy, overweight, cardiac disease, and so on). Barley and its products in recent years have gained an importance due to its counteractive components, which play potent role against cardiovascular diseases by lowering down the oxidative stress and improving high-density lipoprotein, further lowering down low-density lipoprotein, VLDL ratios, further regulating insulin levels and lowering down the spike in blood glucose levels, showing potent antioxidative and cardiovascular functions.