Cardiovascular diseases remain the leading cause of mortality worldwide, with particularly high burdens observed in countries undergoing socioeconomic transition. A growing body of evidence highlights the central role of oxidative stress in the pathogenesis of atherosclerosis, thrombosis, and related cardiovascular disorders. Selenium, an essential trace element, has attracted sustained scientific attention due to its incorporation into selenoproteins with critical antioxidant and anti-inflammatory functions. This article presents a comprehensive, integrative analysis of selenium status and its relationship with cardiovascular disease, grounded strictly in the existing scientific literature. Epidemiological patterns of cardiovascular morbidity and mortality in Eastern Europe and Central Asia, including Uzbekistan and Russia, are examined alongside ecological and nutritional determinants of selenium availability. Mechanistic pathways linking selenium-dependent antioxidant systems, particularly glutathione peroxidase, to vascular homeostasis and platelet function are discussed in depth. Methodological approaches for selenium assessment and cardiovascular epidemiology are critically analyzed, emphasizing strengths and limitations inherent in population-based research. The results synthesized from prior studies suggest that suboptimal selenium status may exacerbate oxidative stress, endothelial dysfunction, and inflammatory responses, thereby contributing to increased cardiovascular risk. However, inconsistencies across studies underscore the complexity of selenium biology, including dose-response relationships, regional variability, and interactions with lifestyle factors such as smoking. The discussion addresses theoretical implications, unresolved controversies, and directions for future research, particularly the need for context-specific nutritional strategies and carefully designed intervention studies. This article aims to provide a rigorous conceptual framework for understanding selenium’s role in cardiovascular health and to inform both scientific inquiry and public health policy.