By Janet Poveromo
In regards to cardiovascular health in this country, there was a little bit of good news earlier this year. New mortality data from the Centers for Disease Control and Prevention (CDC) shows that, since 1999, coronary heart disease and stroke age-adjusted death rates are down by 25.8 percent and 24.4 percent, respectively.
As encouraging as that is, heart disease and stroke remain the No. 1 and No. 3 causes of death for men and women in the US.
Potential problems loom in the future, however, as all major risk factors for these leading causes of death are still too high and several—such as obesity and type 2 diabetes—are actually on the rise.
Not surprisingly, the latest HealthFocus International Consumer Trend Report confirms that heart disease continues to be the No. 1 health issue for US consumers. Hypertension/high blood pressure ranks No. 8 and is a growing consumer concern.
While ranking eighth, hypertension is a significant and growing concern amongst 45 percent of the population, up from 40 percent in 2002, noted Peter Willis, senior marketing manager with DSM Nutritional Products, Inc. (Parsippany, NJ). “The American Heart Association estimates that about one in three US adults has high blood pressure, but because there are no symptoms, nearly one-third of these people don’t know they have it,” he added.
Attacking Different Fronts
With these statistics in mind, ingredient manufacturers are addressing cardiovascular health in broad terms.
First, they are looking into conducting more clinical trials on the proprietary and branded ingredients, said WH Leong, vice president of Carotech, Inc. (Edison, NJ), makers of Tocomin®.
That is the basis, agreed Lucien Hernandez, president of Natreon, Inc. (New Brunswick, NJ). “As with any therapeutic indication, marketers look first to the science as the foundation for benefit statements. With cardiovascular health, doctors say eat a healthy diet, exercise regularly and avoid the classical risk factors of smoking, obesity, sedentary lifestyle, elevated cholesterol, hyperglycemia and high blood pressure. That’s where message strategy must start and that’s why nutritional supplement marketers want ingredients that deliver on promises that speak to those risk factors.”
Jaleah Hawkins, sales manager with HerbaKraft (Piscataway, NJ), pointed out that since heart disease encompasses more than any single dysfunction, an array of supplements are available.
“Manufacturers are attempting to attack heart disease from different fronts by providing multi-supplements, rather than single out a particular symptom or risk factor for heart disease,” he added. “Most supplements are multifaceted to provide maximum impact. Many of the products that manufacturers are producing are also made to be incorporated into the daily diet. While supplements in pill form are still very common, those that can be taken in the form of a drink, candy or with a meal are emerging as a substantial category. Chocolate bars with twice the anti-oxidative power, fruit drinks that reduce blood pressure, fibrous cereals that reduce cholesterol, and even sodas packed with heart-healthy minerals seem to be springing up in grocery stores everywhere instead of the pharmacy.”
Origins of Heart Disease
“Unfortunately, the cholesterol story still is the No. 1 factor that the media presents as a major etiology in coronary artery disease,” said Stephen T. Sinatra, MD, FACC, CNS and author of The Sinatra Solution/Metabolic Cardiology. “Although cholesterol plays a very small role, and is found at the crime, it is not the perpetrator,” Sinatra added. “Inflammation is the real root cause of coronary disease and, unfortunately, this issue is not being addressed. For example, statin drugs, which are potent anti-inflammatory agents, are the reason why some people improve on a program of statins and coronary disease. Lowering LDL cholesterol, another factor of statin intervention, is really not the major reason that these people improve. Statins lower blood viscosity as well as inflammatory mediators and happen to lower cholesterol at the same time, but again, it is not cholesterol lowering but rather the anti-inflammatory mechanism that needs to be addressed.”
Minneapolis, MN-based Bioenergy Life Science, Inc. said its approach to cardiovascular health is to focus on providing energy to the heart muscle, which will maximize performance of the heart and make the individual feel better. “Quality of life is one of our major outcomes for consumers,” said Vice President of Business Development Jim Herrick, RPh, MS. “Health care providers are starting to recognize that the ischemic heart is energy starved,” he added, “pointing out that cellular energy comes from ATP (adenosine triphosphate) and compromised blood circulation depletes ATP over time. This may be secondary to arteriolosclerosis, post heart attack, heart failure, angina and other cardiac diseases. Heart tissue is capable of making new ATP that has been depleted in this manner, but the enzymatic machinery required to do so is in short supply in cardiac and muscle tissue.”
The rate-limiting compound in the synthesis of new ATP is ribose, Herrick explained. Many studies have established that ribose is required to start the process of forming new ATP when muscle tissue is slow to make its own ribose. If ribose is made available to the cell, it can accelerate the replenishment of cellular energy fives time faster than the body can on its own.
“Physicians have employed ribose for various cardiac diseases for a number of years, often with dramatic success,” Herrick said. “But now, in a new text by Gilbert Ling, PhD, Life at the Cell and Below Cell Level, he suggests ATP levels are critical for maintaining general cell health and viability.”
Atherosclerosis and hypertension are two major cardiovascular ailments that are being addressed, Hawkins said. “Antioxidants, in addition to preventing free radical damage, also prevent the oxidation of ‘bad cholesterol’ in the body and therefore may be able to slow the progression of atherosclerosis. Supplements that address cholesterol, inflammation and oxidative stress would also address the risk factors of atherosclerosis.
“High blood pressure, known technically as hypertension, is another very prominent ailment that is being treated. Natural diuretics are the most common supplementation,” Hawkins added.
Besides physical activity and genetics, which appear to be associated with heart health, consumers are turning to dietary supplements aimed at preserving or improving cardiovascular functions. “There are a number of them such as CoQ10, tocotrienols, PS, omega-3 and 6, etc. But what is most important is that these ingredients have to be backed by science and/or clinical trials,” said Leong.
Recent Advances
Ingredient manufacturers who are cognizant of the inflammation/coronary disease connection are making great headway in impacting the inflammation process. For example, Sinatra pointed out, omega-3 essential fatty acids, nattokinase, curcumin, coenzyme Q10, vitamin C and ginger—to mention a few—are simple anti-inflammatory nutraceuticals that seriously have a positive impact in optimizing cardiovascular health. Seanol, a red kelp seaweed, is another anti-inflammatory product. “As a potent inhibitor of NF-kappa-B, I’ve seen improvement in arthritic symptoms and cardiovascular inflammatory mediators,” Sinatra said. “In fact, one of my patients went from a CRP level of 39 down to one on red kelp seaweed. It also raises HDL and lowers cholesterol as well. The nutraceutical industry is cognizant that inhibitors of inflammation will continue to be the focus of new product developments in the future.”
Ingredient suppliers are taking the consumer demand for science backing up claims seriously. Some new research includes Kaneka’s Kaneka QH™, which has been studied extensively in cardio patients and has been shown to be quite beneficial, according to Thomas H. Schrier, national sales manager with Kaneka Nutrients in Pasadena, CA. “In fact, Q10 remains a pharmaceutical drug in Japan for CHD.”
The ingredient is the pre-converted form of CoQ10 (ubiquinone). Upon ingestion, ubiquinone must be absorbed and then converted to ubiquinol, according to Schrier. Ubiquinol is the form that sparks 95 percent of your body’s cellular energy production (ATP) and provides the powerful antioxidant benefits associated with CoQ10. Studies have shown that the pre-converted ubiquinol (KanekaQH) at equivalent dosages has an incredible impact on end-stage cardiovascular patients.
Carotech’s Leong points to a human study on the cholesterol-lowering effect and reversal of arterial blockage in carotid stenosis [blockage and narrowing of the carotid artery in the neck] patients with palm tocotrienol complex (as in Carotech’s Tocomin) with the full spectrum tocotrienols—alpha, beta, gamma and delta—tocotrienol. One published clinical trial is Tan D, et al., 1991, American Journal of Clinical Nutrition, 53: 1027-1030; “Effect of palm oil vitamin E concentrate on serum and lipoprotein lipids in humans.” In this study, the subjects were supplemented with tocotrienols derived from the fruits of oil palm. Over a 30-day period, the magnitude of reduction of serum total cholesterol ranged from five percent to 35.9 percent whereas the reduction of LDL values ranged from 0.9 percent to 37 percent when compared with their respective starting values.
Having noted that, Leong said, “We must also not lose sight of the other proven effects of palm tocotrienol complex that are related to cholesterol in reducing the total risk of cardiovascular diseases, namely palm tocotrienol complex’s ability to reverse arterial blockage and increase blood flow through the carotid artery of carotid stenosis patients.”
Systemic inflammation, and the fact that stress makes it significantly worse, has become a very important advancement in the cardiovascular category, said Natreon’s Hernandez. In a recently published study of Sensoril®, stress-related parameters were significantly reduced in chronically stressed humans. Moreover, in this double-blind, randomized, placebo-controlled study of Sensoril®, serum C-reactive protein was significantly reduced as was LDL cholesterol while HDL cholesterol was increased.
In other notable ingredient news, tripeptides derived from milk protein have been shown to lower blood pressure in numerous clinical studies, but are relatively new in the US, according to Willis. The latest tripeptide product launched is TensGuard from DSM, Willis said. “TensGuard is unique in that it is the only product that contains 100 percent IPP [isoleucine-proline-proline] as the active ingredient to lower blood pressure. The IPP amino acid sequence is hydrolyzed (cleaved) from the protein chain in casein and has shown to have the greatest bioavailability of any tripeptide.”
At HerbaKraft, Hawkins said studies are being performed to find the best treatments for cardiovascular disease with the least significant side effects. Studies with niacin or vitamin B3 are being performed. “In past studies it has shown to increase the effectiveness for HDL cholesterol and decrease the effectiveness of LDL cholesterol,” Hawkins said. “Vitamins C, E and K2 have also been implied in the treatment of cardiovascular disease. Large daily doses of fiber have also become the recommended trend for individuals suffering from high cholesterol. These supplements are being marketed in new formulations such as drinks and cereals. Though they all exist in pill form, new advancements in manufacturing is allowing consumers to take in supplemental doses of these materials as part of their daily diet.”
State of the Market
A recently published report in Nutrition Business Journal showed that sales of heart health-specific supplements grew by 15.9 percent in 2007, as compared to their over-the-counter counterparts at four percent, while prescription products in this category actually declined by 17.6 percent. “These data suggest that consumers are indeed seeking out alternatives to prescription products for heart health,” said DSM’s Willis.
Leong agreed the cardiovascular arena is an evolving and most certainly growing market. “The ability of nutraceutical compounds to alleviate some of the health care economic burden associated with cardiovascular diseases is increasingly critical. This definitely augurs well for the future market of dietary health ingredients with proven science for brain health. As such, I see the market as expanding and growing in the coming years,” he said.
However, Hawkins said he feels that given the current economy, the market is very volatile. “Most companies are looking for new and effective products that provide substantial health benefits and appeal to the average consumer. Many manufacturers are leaning toward organic and additive free products to appeal to consumers. There is also a demand for safer extraction methods and manufacturing practices for herbals and botanicals. Safe, effective, pliable products are the focus for the support of healthy cardiovascular function.”
Hernandez pointed out that many ingredients are aimed at heart health and many food and nutritional supplement products are cardio-positioned. The aging Baby Boomer population will be a major driver of this category already stated, he noted.
One area where there is a particular growth opportunity is in cardiovascular health supplements for women.
“Women have a one in two chance of developing heart disease in their lifetimes. There is a significantly greater risk of developing heart disease than there is of breast cancer. In addition some risk factors for women appear to be more significant than in men. Elevated C-reactive protein levels for example are more closely associated with cardiovascular risk in women than in men,” Hernandez added.
Trends
Many ingredient manufacturers agree that a trend in the market is toward a complete cardiovascular product that contains a host of synergistic phytonutrients that have proven cardio protection properties. “Instead of a single component/ingredient formulation, manufacturers as well as consumers are looking for a multiple cardio-protective ingredients in products (such as a synergistic combination of CoQ10, omega-3 fish oil and tocotrienols in one capsule) as they are perceived to work synergistically as a team to confer the optimum cardio protection,” said Leong.
Whatever ingredients manufacturers choose, safe, natural and organic are product features that will continue to influence purchase decisions as much as promised efficacy, Hernandez said. “Wellness seekers, young and old, are savvy and know the importance of fitness and a healthy lifestyle. Ingredients like Sensoril that are not only safe, natural and effective but also experiential in that its beneficial effects on stress and anxiety have rapid onset of action give marketers promoting heart health a compelling point of differentiation.”
”As awareness builds for heart health, we believe it will move beyond cholesterol and into making the heart stronger and function more efficiently,” Herrick added. “Therefore, we believe the market has a large potential for growth.” NIE |