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Evidence-based alternatives include optimising nutrition with iron-rich foods and complex carbohydrates, taking recommended supplements such as vitamin D (10 micrograms daily), addressing iron deficiency if confirmed by blood tests, ensuring adequate hydration, and prioritising sleep when possible

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The epigenetic role in this context is not fully understood

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Regardless of the mechanisms of cholesterol enrichment, VSMCs compared to macrophages are inefficient at lysosomal processing and trafficking of cholesterol (152,153) and express much less ABCA1(154), which all contribute to impaired cholesterol efflux (155)