As the leading cause of death for both men and women, heart disease is alarming enough—and now, news linking the very treatments designed to help protect heart health to cancer are giving consumers even more cause of concern. Reports about the safety of commonly prescribed blood pressure medications dominated the health news headlines in late 2018 and into 2019. A January 2019 CNN headline announced: Heart drug recall expanded again after ongoing FDA testing revealed several drugs were tainted with cancer-causing contaminants (1).

These latest concerns are piled on top of the usual worries some have with pharmaceutical drugs: While these medications are formulated to combat cardiovascular risk factors like high blood pressure, high cholesterol levels and heart-harming stress, many come with their own set of side effects. What’s more, pharmaceuticals may only address one problem, so individuals can end up having to take a myriad of medications. The cost and side effects can quickly add up.

As awareness—and wariness—regarding pharmaceutical drugs grows, consumers may be more motivated to seek out holistic and natural ways to support heart health and avoid being handed a prescription for a drug in the first place. According to the 2018 CRN Consumer Survey on Dietary Supplements, commissioned by the Council for Responsible Nutrition (CRN), heart health is a priority for supplement users over 55; 29% (up 5% from 2019) say it is one of the reasons they take dietary supplements. And it’s not just baby boomers—surveys show an interest in maintaining heart health starts much younger, with millennials also looking to keep their hearts healthy.

A heart-happy lifestyle
Many cardiovascular diseases can be prevented with healthy lifestyle choices, yet heart health is still the number one health threat in the world, points out Trisha Sugarek MacDonald, BS, MS, Sr. director of research & development, Bluebonnet Nutrition Corporation, Sugar Land, TX. “As the Baby Boomer Generation continues to age—416 boomers turn 65 every hour—it is no wonder heart health has been a considerable candidate for debate,” she says. “However, a lot can be done to help protect the cardiovascular system by loving the heart and making the lifestyle changes that are necessary for positive change.”

Consumers can be mindful of factors that are associated with heart health:
• Age/gender: Women over the age of 55, after menopause are more at risk because of hormonal changes. However, in general, males are at a greater risk of developing heart disease. Also, risk increases with age.
• Diet/exercise: Physical inactivity and a diet high in fats and sodium can increase risk.
• Smoking: Tobacco can damage blood and heart vessels. Smokers have a 70% higher death rate from heart disease than non-smokers.
• Alcohol consumption: In excess, alcohol can raise blood pressure levels. According to the CDC, women should have no more than one drink a day; men two.
• Weight/BMI score: Obesity can increase “bad” cholesterol levels and a BMI over 30 can increase chances of developing heart disease. Carrying more weight around the waist than hips also is a sign for being at a higher risk. This risk goes up with a waist size that is greater than 35 inches for women or greater than 40 inches for men.
• Blood lipid levels (elevated cholesterol, triglycerides and phospholipids)
• Lipoprotein profiles (VLDL, LDL, IDL, HDL, chylomicrons)
• High blood pressure
• Elevated homocysteine levels
• Genetic factors: Having a family history of heart disease increases risk.

Another risk factor to consider, which research is proving to be especially important: Emotional distress. In recent years, researchers have investigated an emotion-based approach to heart health due to an interactive system between the brain and the heart, says Melanie Bush, chief science officer of Artemis International, Fort Wayne, ID. “For example, strong emotions such as anger can cause a cascade of stress hormones to pump through the body, which can negatively influence vasoconstriction and blood pressure,” she says. “Usually, the blood pressure would normalize after a time, but if the emotion or stressor is more chronic, this can prevent the body from recovering, causing more lasting damage.”

Moreover, Diyanah Roslan, a nutritionist with ExcelVite in Edison, NJ, points to a 2017 study in The Lancet by Harvard Medical School researchers. The scientists discovered that heightened activity in the amygdala (the brain region that governs emotions) due to stress is strongly associated with heart attack and stroke.

Up to 90% of all illness and disease—not just cardiovascular—is stress-related, adds Karen Jensen, N.D., a health educator with Natural Factors, Monroe, WA. “Stress hormones are powerful anti-inflammatory agents initially, but chronic stress alters the effectiveness of cortisol, the main stress hormone, to regulate the inflammatory response and inflammation gets out of control.” Increased cortisol has been associated with higher blood sugar, obesity, insulin resistance, abnormal lipids and hypertension, as well as changes that promote the buildup of plaque deposits in the arteries.

“Since ancient times, what has been most iconic symbol to reference our emotional state? The human heart of course. So is it really that surprising that modern science has uncovered a link between our emotional state and heart health?” contends Sugarek MacDonald. A connection also has been observed between lack of sleep, stress and high blood pressure. “In fact, one of the strongest levels of research to reduce blood pressure is the use of melatonin, because it relaxes the body and quiets the mind. It has been found that melatonin intake—daily for 3 weeks— at a dosage of 2.5 mg, reduced systolic and diastolic blood pressure during sleep by 6 and 4 mm Hg, respectively.” For customers struggling with stress and/or poor sleep, melatonin may be their answer to feeling more relaxed and rested while also safeguarding their heart and overall health.

Exercise also can go a long way with easing emotional distress and protecting the heart, and Roslan notes the benefits of adopting a daily routine of mindfulness (such as meditation or breathing exercises) to manage stress.

A healthy diet is significant as well. Trading highly processed foods (plus giving up tobacco and excessive alcohol) for a diet rich in fresh vegetables and other whole foods, can minimize risk. And Katrin Berntsen, director of communications, Aker Biomarine Antarctic AS, recommends replacing unhealthy fats with healthy fats including two weekly servings of oily fish a week. “The best way to increase omega-3 levels is to consume ‘oily’ fish—i.e., salmon, herring, albacore tuna and sardines. Or take omega-3 supplements such as krill, fish or algal oil.”

A helping hand from supplements
Since many consumers won’t overhaul their lifestyle overnight, supplements can offer an assist. Retailers can play the “supplementation role” for customers who may not be giving their heart what it needs for optimal health, says John Sauve, VP marketing, Artemis International, Fort Wayne, ID. Of course, consumers should always check with their healthcare provider before taking supplements. Here, several to consider:

Vitamin E
In the past, various clinical trials involving vitamin E and heart health have not shown consistently positive results. Some experts have written the nutrient off, considering it ineffective at protecting the heart; consuming high dosage of vitamin E has been discouraged. But not so fast, says Roslan. The media, the researchers or the medical teams involved in conducting and publishing these studies may not have realized at that time that the studies have used only one type of vitamin E— alpha-tocopherol, and that some of the studies involved the synthetic form.

“However, studies using palm tocotrienol have showed that this other form of vitamin E could improve heart health via improving arterial compliance and maintaining healthy cholesterol level,” Roslan states. ExcelVite’s ingredient for heart health, EVNol SupraBio, is a patented and bioenhanced palm tocotrienol complex that is sustainability sourced and extracted from non-GMO Malaysian red palm oil.

“Alpha-tocopherol is no longer the universal and only vitamin E choice to consider,” seconds Anne Trias, M.S., product director, American River Nutrition, LLC, Hadley, MA. She explains vitamin E is the most prevalent and important antioxidant in the lipid cell membrane, and is uniquely shaped to reside within the bilayer to protect its integrity. The tocotrienol form of vitamin E, she says, is 50-fold more potent as an antioxidant compared to tocopherol.

Another advantage is its hypocholesterolemic and anti-inflammatory properties. Trias says tocotrienol can improve Fatty Liver Index, and lower triglycerides, body weight and inflammatory markers. Tocotrienol also has also been found effective in improving insulin and glucose sensitivity, aiding cardiovascular function. “One critical element,” Trias adds, “is to consistently recommend tocotrienol supplementation apart from alpha-tocopherol, as combining the two was repeatedly shown to interfere with tocotrienol functions and benefits.”

Krill Oil & Omegas
An important point to make your customers aware of is the Omega-3 Index blood test. “While we understand that omega-3s are essential for our health, we can’t ‘feel’ a low omega-3 level, just as we can’t feel a high cholesterol level or high blood sugar level or even high blood pressure,” says Berntsen. The Omega-3 Index ranges from about 3% to 12% (or more) and those with higher levels are at a lower rate for heart disease. She says that some experts are calling this test the “new cholesterol test”—something your customers can discuss with their healthcare providers.

Krill oil may help boost that Omega-3 Index, adds Bernsten, who notes that krill’s omega-3s are carried directly into the blood via the phospholipids (an important component of cell membranes). She explains that this helps efficiently raise index numbers. “And krill contains the essential nutrient choline as well as astaxanthin.” To help consumers get these benefits, Aker Biomarine has expanded from their flagship product, Superba Krill and created Superba 2 and Superba Boost.

Indeed, krill oil has been shown to significantly decrease both diastolic and systolic blood pressure, thereby enhancing cardiovascular health.“ Krill oils are different in the amounts of Omega-3 (EPA and DHA) that they offer as well as the amount of phospholipids and astaxanthin contained in the oil,” notes Hank Cheatham, VP, marketing and sales, Daiwa Health Development, Inc., Gardena, CA, who adds that Daiwa offers two krill oil supplements composed of pure oil derived from Antarctic krill. The company’s Super Krill Oil is powered by Superba Boost and is rich in omega3s, phospholipids, choline and astaxanthin.

CoQ10
In traditional medicine, statins have become a go-to treatment for heart problems. CoQ10 is now fairly well-accepted in the medical community for its heart health benefits, and because statins are known to decrease the body’s natural production of this compound, many health practitioners are recommending supplementation alongside the standard treatments.

CoQ10 deficiency has been identified in 50 to 75% of heart tissue biopsies in patients with various heart conditions, Jensen points out. “Many studies show its effectiveness in the treatment of high blood pressure, atherosclerosis, angina, congestive heart failure, and cardiomyopathy.”

Need may increase with age. Sid Shastri, product development manager for Kaneka, Pasadena, TX, which introduced Ubiquinol, an active form of CoQ10 that helps the production of cellular energy so the heart and other organs can function at optimal levels, says, “Most adults produce less Ubiquinone as they age and their ability to convert Ubiquinone to Ubiquinol diminishes with age, resulting in lower levels of Ubiquinol to contribute to cellular energy production.” A supplement can help regulate levels.

Polyphenols
These micronutrients can be absorbed from certain plant-based foods—a common one for heart health is grape seed extract (GSE). A growing body of clinical evidence indicates that GSE can be effective at reducing LDL cholesterol and triglyceride levels.

Other polyphenol-rich options to note: Cloves, dried peppermint, cocoa powder and dark chocolate. Some berries are known as well to have them like blueberries, blackberries, strawberries, raspberries and a new standout: black chokeberry (more on this gem below).

Other polyphenol-rich foods include black currants, plums, cherries, apples, beans, nuts, vegetables, soy, black tea, green tea and red wine.

Aronia Berry
The Aronia berry (Aronia melanocarpa), aka “chokeberry,” has emerged as a heart-health superstar. “Berries have always been understood as an incredibly good-for-you option, but science has expanded our understanding about the specific functionality of particular darkly pigmented berries, and aronia has earned a place as part of any heart health regimen,” says Bush. This powerful berry is native to North America and has been shown in studies to support a healthy heart through several markers such as blood pressure reduction, cholesterol lowering, and inflammation modulation, explains Bush. These health benefits are tied to the flavonoid content of aronia berries including the natural antioxidant anthocyanins.

With these offerings, consumers can enjoy greater peace of mind when it comes to the heart. WF

Spotlight on blood pressure

The most common form of heart disease is high blood pressure, also known as hypertension. Blood pressure values that are above 120/80 mm Hg increase the risk associated with a variety of conditions, explains Sugarek MacDonald. Bluebonnet has added Targeted Choice Blood Pressure Support to help keep BP in the normal range and Sugarek MacDonald shares some additional ingredients that are good for balancing BP and protecting heart health:
• Hawthorn, taurine, vitamin B6, magnesium and CoQ10 have been shown to help increase excretion of bodily fluids thereby inhibiting sodium and water retention that elevate blood pressure.
• Magnesium and hawthorn leaf/flower extract have demonstrated the ability to reduce vasoconstriction by affecting the movement of calcium, causing blood vessels to relax.
• Magnesium, arginine and grape seed extract have been shown to help enhance circulation and blood flow by sending out a signal for
vasodilation.
• Hawthorn, hibiscus, olive leaf, and grape seed, as well as onion and pumpkin, have been shown to decrease hypertensive hormones in the adrenal and pituitary glands by interfering with the conversion of angiotensin II from angiotensin I and inhibiting the degradation of bradykinin, a potent endothelium-dependent vasodilator.
• Grape seed extract, taurine, and CoQ10 exhibit potent antioxidant properties, which is important for heart health.

For more on the FDA’s blood pressure drug recalls

At press time, the list of the prescription blood pressure medications that had been
recalled by the FDA was long—and growing. A full list can be found at: https://www.fda.gov/downloads/Drugs/DrugSafety/UCM615703.pdf.

The American Heart Association also issued an alert, warning that people should not stop taking their medication without contacting their doctor, as the abruptly stopping a blood
pressure lowering drug could come with significant risks (3).

References:
1. CNN, “Heart drug recall expanded again,” https://www.cnn.com/2019/01/04/health/valsartan-recall-fda-expands/index.html

2. CRN, https://www.crnusa.org/CRNConsumerSurvey

3. https://www.heart.org/en/alerts/blood-pressure-medication-recall-alert