2023 Heart Health Update

Consumers are more invested in taking proactive measures to protect their heart than ever before.

heart health vitamin graphic

Consumers are more invested in taking proactive measures to protect their heart than ever before. “We know heart disease has been the leading cause of health-related death in the world, but there are new factors playing a role in increasing consumer awareness and emphasis on heart health,” says Vishal Shah, Whole-Time Director, Nutriventia Limited. “COVID prompted consumers to focus more on their general health and well-being, and the higher risk of cardiovascular problems due to COVID has brought greater consumer concern for their heart health.”

Indeed, a 2022 Cleveland Clinic survey found that 41% of Americans experienced at least one heart-related health issue, including shortness of breath, high blood pressure, and chest pain, since early 2020. “Individuals ranked the COVID-Era relative to seriousness for themselves; personally, it was a reality check for everyone that we do not live in a vacuum and mitigating risk is paramount,” says Chris D. Meletis, Naturopathic Physician with Trace Minerals. “Since heart disease topped the list of mortality before, this is a time of ‘cardiovascular disease awakening.’”

Beyond COVID, consumers increasingly understand that supporting the heart can help improve overall well-being, adds Shah. “There has been a shift from prevention of negative health outcomes and health maintenance to optimization of health—on one side because of COVID and on the other from younger generations doing what it takes to be in peak health. It comes down to optimal performance on a day-to-day basis, during exercise, and at work. It’s about getting the most out of life for this group.”

Also noting a shift in interest in heart health across demographics, Karin Hermoni, Ph.D., Head of Science and Nutrition for Lycored, says, “In the past, heart health was closely associated with healthy aging, and older consumers were seen as the most important target market. Now, it’s increasingly likely to be connected with areas like sports, performance and energy, and with a younger demographic.”

Whether customers are looking to prevent heart disease or improve function, diet and exercise remain the first line of defense. “There is no magic bullet for cardiovascular disease (CVD) since it is a multi-faceted condition,” says Trisha Sugarek MacDonald, BS, MS, Sr. Director of Research & Development and National Educator, Bluebonnet Nutrition Corporation. “A lot can be done to help protect the cardiovascular system by making lifestyle modifications necessary for positive change. Remember, an ounce of prevention is worth a pound of cure.”

Proper nutrition is an advantage to healthy living, says Dr. Stacey Smith, Marketing and Communications Manager NORAM, Gnosis by Lesaffre. “Still, it is more evident than ever that we are not obtaining all the nutrients we need from food. Consumers are seeking heart-healthy supplements to fill in the gaps and make a significant impact on their optimal nutrition status.”

“There has been a shift from prevention of negative health outcomes and health
maintenance to optimization of health.”

Vishal Shah, Nutriventia Limited 

Smart strategies to supercharge sales

Retailers are in a sweet spot to boost the bottom line by appealing to younger generations interested in heart health in addition to aging customers. “The Millennial and younger generations seem to acknowledge the importance of lifelong supplementation better than their elders, who sometimes wait until a warning light goes on to seek nutritional support,” says Neil Edward Levin, CCN, DANLA, Senior Nutrition Education Manager, NOW. He notes that one way to appeal to this demographic is by highlighting heart-healthy supplements with an energy or performance angle. “Younger generations are choosing products like Carnipure L-carnitine that may give them sports nutrition benefits today, but will also support their heart health tomorrow.”

Higher-octane support may also hold broad appeal, Levin says. “For several years, we have seen strong growth in basic cardiovascular-friendly nutrients such as omega-3 formulas, vitamin K2 as MK-7, chelated magnesium, and vitamin D. The trend is toward higher strengths: vitamin D3 5,000 IU-10,000 IU, vitamin K2 as MK-7 in strengths of 160-300 mcg daily, EPA and DHA in combined strengths of 1,000 to 3,000 mg per day. We suggest that retailers stock these higher-strength formulas to meet consumer demand.” More smart strategies to grow sales:

Engage in the conversation: “For retailers, creating a heart-health endcap display can invite more customers to explore heart-specific supplements and engage with staff about cardiovascular health,” suggests Jay Levy, National Sales Director of Wakunaga of America Co., Ltd. To this end, he advises adding shelf talkers to a heart health section. Having printed materials designed to educate consumers on hand can also encourage higher sales and more educated customers.

Get specific: “Consumers are now looking to supplement their diets and daily exercise regimens with condition-specific formulas for blood pressure, cholesterol support, antioxidant replenishment, and prostaglandin balance rather than just general one-a-day formulas to maximize their efforts to maintain good heart health,” says Sugarek MacDonald. She advises dividing the heart-health section into subsections that address common heart-health issues so it is easier for customers to find what they’re looking for when shopping. Subsections might include cholesterol, blood pressure, triglycerides, and homocysteine levels.

Highlight value-added benefits: Customers who feel like they’re getting more bang for their buck are more likely to be repeat customers, and heart-health supplements offer a great opportunity to promote double (or triple!) duty benefits. “It’s important for consumers to understand that heart health is an underlying condition for many other health conditions—and finding natural ingredients that can benefit your body holistically is important,” explains Sébastien Bornet, VP Global Sales & Marketing at Horphag Research. ”For example, researchers continue to study Pycnogenol’s ability to work on heart health, and its relation to lowering the risk for other conditions in which heart health is an underlying factor. A 2020 study not only found Pycnogenol’s ability to improve erectile dysfunction symptoms, but participants also reported additional cardiovascular benefits, including a 20% reduction of LDL cholesterol in the diabetes participant group, a 14% improvement of LDL cholesterol in the ED-only participant group, and a 22% improvement of serum glucose in the diabetes participant group.”

Nutrients that nurture the heart

Dr. Meletis touts supporting the basics of inflammation control, good omega fatty acid intake, and supporting heart energetics with CoQ10, NAD, carnitine, magnesium, electrolytes, and vitamins and minerals. ”Cholesterol and blood sugar support are cornerstones. Also, since most North Americans do not consume the minimum recommended fruits and veggies, food as a therapeutic consideration needs to be brought to the forefront. Green drinks include Green Paks that can be used on the run and mixed in a container to augment one’s diet. There is a reason that ‘food as thy medicine’ still rings true. After doing our best at any given point in time with our diet, stress, sleep, and exercise, this is where supplementation truly thrives.”

We asked experts to highlight a few supplements with standout benefits and science.

Aged Garlic Extract (AGE): Wakunaga’s flagship ingredient Aged Garlic Extract (AGE) offers a concentrated dose of garlic phytonutrients shown to reduce heart health risk factors. “AGE has been the subject of more than 900 peer-reviewed, published scientific papers showing its ability to reduce cholesterol and blood pressure levels, slow the progression of coronary artery calcification, decrease the formation of low-attenuation (soft) plaque, and prevent oxidative stress that contributes to atherosclerosis,” says Levy. He points to two clinical studies at Lund University’s Skåne University Hospital in Sweden, as proof of AGE’s cardiovascular capabilities. “The first found that Kyolic AGE reduced pro-inflammatory interleukin-6 and C-reactive protein in a group of women with low to intermediate risk of cardiovascular disease. The second study reported that AGE boosted microcirculation in the extremities by 21.6%, leading the researchers to note that supplementation may improve wound healing in those with atherosclerosis.”

Ashwagandha: Stress management is an important part of a heart-healthy protocol, and adaptogens like ashwagandha can help keep moods stable. “Ashwagandha plays a role in heart health by supporting oxygen utilization and performance, and by promoting healthy stress and cortisol levels,” says Shah, noting that Nutriventia offers Prolanza, a long-acting proprietary ashwagandha extract that provides stress management support for 8 to 12 hours. “​​In a randomized clinical trial, Prolanza was shown compared to placebo to significantly reduce serum cortisol and perceived stress levels and improve sleep quality and mental wellbeing.”(For more on adaptogens, see page 20.)

Coenzyme Q10: Often sold as CoQ10 or ubiquinone, this lipid-soluble, vitamin-like substance is present in nearly all human tissues and is essential for the cellular processes of energy production in the mitochondria, says Sugarek MacDonald. “It has a long successful track record in supporting cardiovascular health. In addition, CoQ10 acts as a potent antioxidant in both the mitochondria and lipid membranes by scavenging free radicals directly or in conjunction with alpha-tocopherol.”

Curcumin: There’s growing evidence that polyphenols can offer big heart health benefits, says Shah. “For example, with its potent antioxidant and anti-inflammatory activity, curcumin has been shown to modify gene expression and modulate multiple signaling pathways associated with cellular health, promoting healthy cellular proliferation, aging, and survival. Science also demonstrates curcumin’s ability to support healthy endothelial function and blood lipids.” Research has shown that curcumin can lower blood pressure and protect against arteriosclerosis. Nutriventia’s turmeric extract TurmXTRA60N is water-dispersible and standardized to 60% curcuminoids content (with all three active curcuminoids) with a recommended 250-mg input.

French Maritime Pine Bark: Branded as Pycnogenol, this extract helps promote heart health through several different channels. “Pycnogenol is a powerful antioxidant shown to help boost circulation, normalize blood pressure, manage cholesterol levels and inflammation in the body and may reduce risk factors associated with metabolic syndrome,” notes Bonet. “Pycnogenol is supported by a vast catalog of clinical research for its heart health benefits. For instance, an 8-week randomized, double-blind, placebo-controlled cross-over study found Pycnogenol improved endothelial function by 32% in stable patients with coronary artery disease. Additional studies have shown Pycnogenol to naturally reduce cardiovascular risk factors in diabetic individuals, including lower blood sugar levels, LDL (low-density lipoprotein) cholesterol and blood pressure.”

Folate: “Recent research has uncovered the role of B vitamins, particularly folate, in reducing and normalizing homocysteine levels effectively,” notes Dr. Smith. She explains that homocysteine (Hcy) is a common amino acid found in the bloodstream that is recognized as an independent cardiovascular risk factor: When Hcy levels are greater than normal (15 µmol/L), there is a disruption of Hcy metabolism, associated with arterial inflammation and damage, as well as an increased risk of cardiovascular diseases. Folate works to maintain lower Hcy levels by converting it to methionine.

Dr. Smith stresses that some forms of folate work better than others. “When we use the term folate, we are referring to the generic term given to vitamin B9, including the synthetic folic acid form, food folates, and the biologically active form 5-MethylTetraHydroFolate or 5-MTHF. ‘Folate’ and ‘folic acid’ are often used interchangeably, causing considerable confusion. The bioavailability and metabolism of folates actually differ due to their respective chemical structures,” she explains. “Quatrefolic from Gnosis by Lesaffre offers tangible advantages versus folic acid and can promote healthier heart life—better folate blood levels directly translate to lower Hcy levels.” Dr. Smith adds that clinical trials have demonstrated that 400mcg of Quatrefolic lowered Hcy serum levels better than conventional high-dose folic acid supplementation (5 mg/day).

Magnesium: This trace mineral plays a vital role in over 300 enzymatic reactions in the body—many of which influence heart health. “Imbalances of trace minerals have been linked to cardiovascular risk factors, as acknowledged by Health Canada,” notes Levin. “The Nurses’ Health Study followed 88,375 women for 26 years, and found the incidence of sudden cardiac death was 77% lower in those with the highest serum magnesium levels.”

Omega-3s: The cardio-protective effects of omega-3s are well-understood by consumers, but the quality and efficacy of supplements can vary. When stocking products, look for options that are free of heavy metals and offer a balanced proportion of EPA and DHA. Also consider non-triglyceride forms, suggests Levin, who says they are recommended over low-strength natural fish oils and higher-strength distilled-and-reconverted triglyceride form oils for supporting healthy triglyceride levels. NOW offers Ultra Omega-3 softgels (500 mg EPA and 250 mg DHA, in esterified form). Bluebonnet also has an Omega-3 Heart Formula, which supplies 800mg EPA and 600 mg DHA.

Within this category, krill oil also offers a concentrated dose of omega-3s with additional antioxidant support. “Krill oil, a multi-nutrient complex that works at the cellular level to give you head-to-toe health benefits, has been a heart health staple since inception,” affirms Charles Ross, SVP HH&N Americas, Aker BioMarine Antarctic US. “Multiple studies over time have confirmed that krill oil is an effective supplement for people at risk of cardiovascular disease. Krill oil supports the three markers of heart health: triglycerides, cholesterol and increasing omega-3 levels.”

Ross notes that a 2022 study in JAMA Network showed krill oil significantly reduces triglyceride levels in the blood. The reduction drop was even higher in patients taking certain lipid-lowering medications. “Maintaining healthy triglyceride levels is vital for overall heart health. The potential impact on improving heart health worldwide, while at the same time reducing healthcare costs, is enormous,” says Ross. “Superba Krill oil, Aker BioMarine’s flagship ingredient, is backed by eight clinical studies proving the heart health benefits of krill oil.”

Onion: “Since ancient times, people have used onions to boost stamina and general health in India, the Middle East, and Europe, and their efficacies were also documented in numerous scientific studies. According to these documents, the most promising effect of onion is that it helps with blood sugar support and cardiac and cerebrovascular health,” says Sugarek MacDonald. OPtain120, a standardized extract of 50% onion and 50% pumpkin, has been shown to inhibit activity of angiotensin-converting-enzyme (AGE), helping to lower blood pressure. “One clinical trial showed a 6% systolic drop in just 12 weeks,” she says. “OPtain, which is found in Bluebonnet’s Targeted Choice Blood Pressure Support, also helps promote the restoration of healthy endothelial function. Endothelial tissue makes up the blood vessels’ interior lining, so healthy endothelial function translates to proper blood flow and healthy blood pressure.”

Plant Sterols: “Plant sterols may inhibit the absorption of dietary cholesterol by displacing cholesterol from bile salt micelles in the lower region of the small intestine, a prerequisite for the uptake of cholesterol,” says Sugarek MacDonald. “When taken at a dosage level of 2 grams/daily, plant sterols have been found to reduce LDL-C levels by 10%.” Bluebonnet offers Plant Sterol 500 mg Vegetable Capsules formulated with 50% beta-sitosterol from sunflower.

Red Yeast Rice: “Red yeast rice is the product of rice fermentation from various strains of the yeast Monascus purpureus that has been used for centuries in China in foods and medicines,” notes Sugarek MacDonald. “Bluebonnet’s CholesteRice Red Yeast Rice Complex Vegetable Capsules provide these complementary and synergistic ingredients at significant levels, along with trans-isomer CoQ10, an antioxidant to help reduce free radical damage.”

Tomato Extract: Lycopene, the plant pigment that gives tomatoes their vibrant hue, has been shown to benefit the heart. But scientists at Lycored were surprised to find that tomatoes have additional active ingredients that further support heart health. “We’re constantly learning more about the potential of tomato phytonutrients in cardiovascular health,” says Dr. Hermoni. “For example, in a 2019 study our tomato nutrient complex was found to be linked to a beneficial effect on blood pressure while lycopene alone was not. This suggests that the myriad active nutrients in our extract work synergistically to drive significant benefits.” The company’s Cardiomato is a proprietary mix of lycopene and phytosterols designed to support cardiometabolic wellness. “In addition to the benefits of the tomato extract, this composition has been shown to balance levels of oxidized LDL—the most impactful form of cholesterol—and to improve cardiometabolic response in areas such as insulin sensitivity.”

Vitamin K2: This nutrient plays a role in removing calcium from tissues like the arteries and shuttling it into the bone. This can help reduce atherosclerosis caused by plaque build-up and vascular calcification, plus strengthens bones—a win-win, says Jeff Lind, National Director B2B Sales, Novozymes OneHealth. “With continuing growth in awareness of vitamin K2’s benefits among both medical practitioners and consumers, we expect ongoing growth in this category, especially in the cardio support segment.  Historically the focus on heart health research and treatment has focused primarily on the male population, but there is now more emphasis on understanding heart health in women.”

A  double-blind, placebo-controlled clinical study of 244 postmenopausal women taking a daily 180-mcg dose of vitamin K2 (as MK-7) for three years showed an increase in arterial elasticity and a reduction in age-related arterial stiffening. Vitamin K2 is the only compound shown to significantly reduce arterial calcification.

Dr. Smith says Gnosis’ MenaQ7 has been the source material for 22+ published human clinical trials confirming safe and efficacious bone and cardiovascular benefits, with more underway. (See the company’s latest news here.)

Combining Nutraceuticals & Pharmaceuticals

“Consumers should always consult their healthcare practitioner about the best way to potentiate benefits through nutrition and supplementation, especially when taking pharmaceuticals, to ensure no negative interaction,” says Dr. Hermoni. That said, supplements can offer a helping hand. For instance, Sugarek MacDonald suggests that people on statins consider a protocol of plant sterols, fiber (psyllium husk), and omega-3s to further support heart health. “What is great about these three supplemental products is that they can be taken in conjunction with statins for a more dynamic reduction in total cholesterol, LDL-C, and triglycerides.” WF

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