Every time the average American gets in his car, he buckles his seatbelt. Most Americans wear seatbelts when they drive (80 percent all of the time and 90 percent on highways, according to the National Highway Traffic Safety Administration (NHTSA)). That same average Joe in his car may also stop at a fast-food joint while in his car and pick up a high-fat, sodium-filled, high-caloric meal and enjoy a sugary soda to boot. That seat belt is likely to protect him from being one of the 41,000 people who die in car accidents every year; but, that cheeseburger puts him at an even higher risk of being one of the 652,000 that die of heart disease in the United States each year, according to the American Heart Association (AHA). If his life takes that turn, he wont be alone, as 27 percent of all U.S. deaths are caused by heart disease. If he doesnt face death, he could be one of the more than 71 million Americans who suffer from with one or more forms of cardiovascular disease (CVD).

With so many Americans facing this disease, its no wonder they say they are concerned with CVD. The International Food Information Councils (IFIC) Functional Foods/Foods for Health consumer survey released in August 2009 found CVD, which includes heart disease, blood pressure, cholesterol and stroke, is the number one health concern, with 48 percent of responders saying it was the most important. That same survey found 85 percent think foods and beverages can help improve heart health.

This awareness and need for our country to reduce the number one cause of death has spurred the market for ingredients that promote heart health.

Functional products for heart health have been embraced by consumers because of the high prevalence of heart disease and increased awareness of products that help support a healthy heart, said Paul Dijkstra, CEO, InterHealth Nutraceuticals. The heart-health category has undergone somewhat of a revolutionary process during the past decade or so. There is an interrelated triage of consumer interest, product activity and manufacturer intent. Along with the increased interest and awareness on the consumer and professional side about the importance of supplementationusing nutraceuticals as well as functional foods and beveragesfor maintaining a healthy cardiovascular system, manufacturers have significantly increased their research activities developing new compounds and new product forms much to the liking of consumers.

Dijkstra also noted according to Mintel, functional products positioned for cardiovascular health hold a 15 percent market, which is second only to products with digestive health claims.

 Matt Phillips, president, Cyvex Nutrition, said he has noticed increasing product launches with heart-healthy ingredients. Perhaps the most significant trend is the increasing number of functional foods and beverages that contain viable and stable amounts of a variety of nutraceutical ingredients specific to heart health, he said. We feel this trend is so strong and will continue because basically, people need to eat and drink to survive. So, why not consume foods and beverages that actually support the structure and function of the cardiovascular system?

Phillips said he has seen younger people taking control of their health early. He noted, We are seeing younger adults (30-somethings) being very aware of cardiovascular health, which was practically unheard of only a couple of decades ago. This is great news, too, as it reflects how the mainstream media has continued to encourage people of all ages to take care of their hearts and their overall health. The messaging is out there and continues, and the industry needs to build upon that to provide quality heart-health products for our modern lifestyle.

Industry members say product launches with heart-health ingredients are up, and those are the few good sellers during these difficult economic times. In Cognis financial statement of the first half of 2009, its Nutrition & Health segment saw sales decrease by 8 percent globally; but sales of its plant sterol ingredients were robust. Just like almost all other manufacturers, in general we saw a decrease in sales, but our plant sterol sales carried the business for the first half, said Laura Troha, marketing manager, Cognis Nutrition & Health. Although weve all been hit hard with economic struggles, Cognis in particular has seen our heart-health ingredients outperform our other ingredients in our portfolio.

The strength of the heart-health category is due to its popularity in both functional foods and supplements, Troha continued. We still have many existing consumer products in the dietary supplement area as well as projects with major food manufacturers, she said. The industry is trying to meet the needs of all different kinds of consumers. Some people would like to get their nutrients from food, whereas a lot of people still prefer to take a pill every day to get the benefits they need. Were seeing equal activity in both markets.

More product launches means more companies are getting in the game and providing a wide variety of functional foods and supplements they hope to be hot sellers. The market continues to be more competitive, said Pam Stauffer, global marketing programs manager, Cargill Health and Nutrition. Its really up to us to continue to step up to the plate and deliver more value than the competition, whether that be a marketing report program or application support. Its really an opportunity to rise to the challenge. People continue to get busier and have less time to spend at the grocery store reading labels, so we need to make sure our messages hit them in the right places. With the economy too, people sometimes have to make tough decisions at the grocery store on what they get or dont get. We need to be compelling enough to make it into the grocery cart when some people are starting to limit the number of items they purchase.

Competition is getting intense in this market, but because many issues relating to heart health, like cholesterol and blood pressure, are numerical, consumers can see if products work. And, those products that dont work are sure to see their sales decline. CoroWise and BarLiv (from Cargill Health and Nutrition) have been clinically shown to reduce cholesterol and thats a great benefit of these products, Stauffer said. Because its something you can measure, you know that its working. There is that sense of satisfaction.

All of this adds up to continued positive momentum for preventive nutrition. The greatest public misconception about CVD may be the idea that it is an unpreventable condition that automatically comes with aging, sooner or later, Dijkstra said. Awareness is the first step in supporting a healthy heart. There needs to be an increased understanding that it takes a multifaceted approach to supporting good heart health. A combination of weight reduction, healthy diet, moderate and regular exercise and science-backed dietary supplements and functional food and beverages may help maintain heart health.

The combination Dijkstra describes is a recipe for good health. Another popular combination in this area is including more than one heart-health ingredient in finished products. Were seeing more and more companies offer more than one health-enhancing ingredient in a supplement or a food, Troha said. You have many companies that are looking to have additive synergistic effects with more than one heart-health ingredient.

Then, there are products that address more than one heart condition. Often overlooked is the need to address both heart health and blood sugar management in one product, Dijkstra said. Diabetes itself causes blood vessel damage, which can accelerate cardiovascular problems. In fact, heart disease and diabetes are very closely related. Persons with diabetes are at a much greater risk for heart attacks, strokes and high blood pressure.

Another trend is adding these heart-healthy ingredients into every day foods. Being that heart health is still the number one concern within the U.S. population, we are seeing more and more foods being rolled out that have these ingredients incorporated into them, Troha said. Were seeing sterols being formulated into sliced bread and in daily dose yogurt shots. Omega-3s are also being incorporated into such food matrices. Were noticing brand marketers getting these ingredients into everyday consumable products. Every day, people are having bread. Every day, people are having their milk.

Consumers seem to be increasingly agreeable to ingesting ingredients good for the heart via functional foods or supplements, but effective marketing is key to sales longevity. Stauffer said she has seen some heart-health product sales increasing and some hitting a plateau. It varies on how the manufacturer positions the end product, she noted. Some weve seen dont go into a lot of detail on why a product lowers cholesterol. They might have more difficulty because the consumer isnt able to readily understand. She added one of the reasons Cargill developed the CoroWise brand of plant sterols was to help communicate a scientific benefit in a more consumer-friendly way.

Feeding the Heart

The efforts of Cargill and other plant sterol companies look as if they have helped, as awareness that plant sterols reduce the risk of heart disease increased to 45 percent in 2009, from 30 percent in 2007, according to the IFIC survey. We were pleased to see those numbers because it confirmed what we have seen in terms of our open projects with brand marketers, Troha said. We are very excited by the uptick in the awareness of these ingredients as well as the uptick with the number of projects with the major food companies. She added Cognis plant sterol ingredients will be in a variety of new products launched within the next year.

Plant sterols, also called phytosterols, are found in all plants, with vegetables, seeds and nuts providing rich sources. They are fat-like plant compounds with chemical structures similar to cholesterol. Plant sterols compete with cholesterol in the body, so when a person digests more plant sterols, he absorbs less cholesterol.

The evidence during the past 50 years that has shown plant sterols can reduce low-density lipoprotein (LDL) cholesterol convinced FDA to authorize a health claim about plant sterols and heart health. In 2000, the agency OKd the claim, Foods containing at least .65 grams per serving of plant sterol esters, eaten twice a day with meals for a daily total intake of at least 1.3 grams, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease.

With an estimated 101 million American adults with borderline-high or higher cholesterol levels, according to AHA, and recognition from FDA, plant sterols are a hot ingredient in America. The beautiful thing about these products is they have an unqualified health claim from FDA, which is really the highest health claim you can get in the United States, Troha said. These products, naturally sourced by Cognis, can reduce bad cholesterol up to 15 percent and there is significant science that demonstrates that efficacy.

Indeed, studies have shown orange juice fortified with plant sterols reduces LDL cholesterol,¹ they are safe to use over a long period of time,² supplementation with them lowers LDL cholesterol in people with an increased risk for coronary heart disease,³ and margarine containing plant sterols was shown to be effective in reducing serum cholesterol.⁴ One study showed the cholesterol-lowering effects of plant sterols may differ according to the type of food matrix.⁵ Plant sterols in low-fat milk was almost three times more effective than in bread and cereals. And, in addition to their cholesterol lowering properties, plant sterols possess anti-cancer, anti-atherogenicity and antioxidation activities.⁶

While it does not hold the same status as plant sterols with FDA, supplementation with chromium picolinate, a stable and highly bioavailable form of chromium, has been shown to reduce insulin resistance and to help reduce the risk of CVD and type 2 diabetes.⁷ Dijkstra said ChromeMate, a patented oxygen-coordinated, niacin bound chromium complex offered by InterHealth Nutraceuticals can do more than that. ChromeMate promotes proper insulin function and normal blood sugar levels, and also has been shown to promote healthy cholesterol levels, normal blood pressure, cardiovascular health and lean body mass, he said. He added ChromeMate also addresses lipid abnormalities, hypertension, inflammation, obesity and oxidative stress.

Resveratrol is another ingredient touted for its ability to fight oxidative stress with its high antioxidant level. It has also shown to have hearth benefits in rat studies^8,9 and has been a popular ingredient for heart-healthy formulations. Cyvex Nutrition offers BioVin®, a full-spectrum extract made with red wine grapes from the Rhone Valley in France. It is a powerful antioxidant that scavenges free radicals, reducing oxidative damage to cells, Phillips said. Through this action of supporting resistance to oxidation, BioVin provides cardiovascular protection. BioVin may also help toward enhancing capillary elasticity and prevent excessive clumping of platelets.

Another ingredients that comes from the vine is bergamot (Citrus bergamia Risso), which grows on the coast of Southern Italy. The active compounds in Citrus bergamot have been identified as naringin, neoeriocitrin and neohesperidin, said Annie Eng, president, HP Ingredients. These compounds have been shown in research to significantly reduce total cholesterol, LDL, triglycerides and blood glucose level, while increasing high-density lipoprotein (HDL). She explained bergamot blocks a key enzyme in the production of cholesterol, which inhibits the livers ability to produce LDL. Indeed, a 2009 study showed the fruit to have statin-like principles.¹⁰ HP Ingredients offers Citrus bergamia is a liquid and dry extract which can enrich products like juices, dairy products, tea and nutrition bars.

Folic acid, a.k.a. vitamin B9, is becoming more known as an ingredient that reduces the risk of heart health. In the IFIC survey, 70 percent of responders said they were aware of folic acids hear- health abilities, compared to 55 percent in 2007.  A recent study showed supplementation of folic acid may improve cardiovascular health and reduce the prevalence of peripheral arterial disease (PAD).¹¹ And in an earlier study, the same group of researchers found 5 mg of folic acid daily over a three-week period reduced pulse pressure compared with a placebo.¹²

Niacin, also part of the B vitamins, has also been shown to improve heart health via raising HDL cholesterol.¹³ When used in combination with cholesterol-lowering drugs, it enhanced the cholesterol-managing effect.¹⁴ According to Lonzas Web site, their niacin ingredient lowers LDL cholesterol, elevates high-density lipoprotein (HDL) cholesterol and reduces the level of triglycerides in the blood.

While the IFIC survey showed most Americans know omega-3s benefit the brain, Troha said consumer awareness of the heart-health benefits of omega-3 essential fatty acids (EFAs) is also significant. Cognis offers Omevital, omega-3 fatty acids of marine origin that combines eicosapentaenoic acid ( EPA) and docosahexaenoic acid (DHA) long-chain fatty acids. The AHA recommends intakes of a combination EPA and DHA ranging from 0.5 to 1.8 g/d (either as fatty fish or supplements) to reduce the risk of heart disease. Studies have shown eating fish two times per week can reduce coronary heart disease¹⁵ and a meta-analysis of 11 trials, published between 1966 and 1999, suggested intake of omega-3 polyunsaturated fatty acids reduced overall mortality, mortality due to myocardial infarction and sudden death in patients with coronary heart disease.¹⁶

The Future

With the shape of American cardio heath in need of a change of heart, these products should have a bright future. We feel that dietary supplements and functional foods/beverages targeting cardiovascular support will continue to be purchased repetitively by consumers, Phillips said. The market continues to grow due to efforts of the AHA and other health agencies that stress the importance of healthy cholesterol management, diet and exercise to ensure the cardiovascular system functions optimally and lessen the risk of development of heart disease.

Stauffer also sees growth potential. From our perspective and looking at our current pipeline, we see a lot of really good, promising new products that are set to launch and opening up some new product categories, she said. Consumers will continue to have a wide variety of choices for how they want to use these ingredients within these products to manage their heart health.

Vincent Hackel, president/CEO of JBSL, predicts 15 percent growth of the heart health market

 Dijstra said the time is now to get into this market. He noted, With the rise in the number of people struggling to manage their blood lipid and blood sugar levels, a growing older consumer base and a shift in awareness to manage and prevent health conditions, it is an ideal time to get into the business of developing products that comprehensively address heart health.

References on the next page...

References for "A Hearty Market for Cardio Products"

1.       Devaraj S, Jialal I, Vega-López S. Plant sterol-fortified orange juice effectively lowers cholesterol levels in mildly hypercholesterolemic healthy individuals. Arterioscler Thromb Vasc Biol. 2004 Mar;24(3):e25-8.

2.       Hendriks HF, et al. Safety of long-term consumption of plant sterol esters-enriched spread. Eur J Clin Nutr. 2003 May;57(5):681-92.

3.       Katan MB, et al. Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels. Mayo Clin Proc. 2003 Aug;78(8):965-78.

4.       Patch CS, Tapsell LC, Williams PG. Plant sterol/stanol prescription is an effective treatment strategy for managing hypercholesterolemia in outpatient clinical practice.  J Am Diet Assoc. 2005 Jan;105(1):46-52

5.       Clifton PM, et al. Cholesterol-lowering effects of plant sterol esters differ in milk, yoghurt, bread and cereal. Eur J Clin Nutr. 2004 Mar;58(3):503-9.

6.       Berger A, Jones PJ, Abumweis SS. Plant sterols: factors affecting their efficacy and safety as functional food ingredients. Lipids Health Dis. 2004 Apr 7;3:5.

7.       Hummel M, Standl E, Schnell O. Chromium in metabolic and cardiovascular disease. Horm Metab Res. 2007 Oct;39(10):743-51.

8.       Bagchi D,et al. Benefits of resveratrol in women's health. Drugs Exp Clin Res. 2001;27(5-6):233-48.

9.       Hung LM, et al. Cardioprotective effect of resveratrol, a natural antioxidant derived from grapes. Cardiovasc Res. 2000 Aug 18;47(3):549-55.

10.   Di Donna L, et al. Statin-like principles of bergamot fruit (Citrus bergamia): isolation of 3-hydroxymethylglutaryl flavonoid glycosides. J Nat Prod. 2009 Jul;72(7):1352-4.

11.   Williams C, et al. Folic acid supplementation for 3 wk reduces pulse pressure and large artery stiffness independent of MTHFR genotype. Am J Clin Nutr. 2005 Jul;82(1):26-31.

12.   Williams C, et al Folic acid supplementation for 3 wk reduces pulse pressure and large artery stiffness independent of MTHFR genotype. Am J Clin Nutr. 2005 Jul;82(1):26-31.

13.   Ganji SH, Kamanna VS, Kashyap ML. Niacin and cholesterol: role in cardiovascular disease (review). J Nutr Biochem. 2003 Jun;14(6):298-305.

14.   Sang ZC , et al. Combined use of extended-release niacin and atorvastatin: safety and effects on lipid modification. Chin Med J (Engl). 2009 Jul 20;122(14):1615-20.

15.   Kromhout D,et al. The inverse relation between fish consumption and 20-year mortality from coronary heart disease. N Engl J Med. 1985 May 9;312(19):1205-9.

16.   Bucher HC, et al. N-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials.  Am J Med. 2002 Mar;112(4):298-304