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During ischemia, the lack of oxygen and nutrients leads to a depletion of ATP and the accumulation of metabolic waste products, creating a highly stressful environment for cardiac cells

A high NAD/NADH ratio such as the oxidized state favors reactions like PHGDH and sustains flux through glycolysis into anabolic routes [15], whereas a reducing environment might slow such biosynthesis and divert pyruvate to lactate instead

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In states of high physiological demands like infancy, pregnancy, lactation, and old age, multiple reasons including malabsorption, dietary restrictions, lactose intolerance, food allergies, or cultural limitations forestall the uptake of the required amount of calcium