NutraSolutions: Getting Heart Smart -- September 2010
Lauren Swann, Concept Nutrition Inc.

Nourishing a healthy heart is a robust $7.18 billion market of food products making cardiovascular health-related claims in the U.S. (See Prepared Foods, May 2010, p. 14. Digital issue available at Food and drink product launches with heart-health positioning have nearly tripled over the past five years, as shown by data from the Innova Database. The U.S. and Europe have dominated this activity, accounting for two thirds of heart-health launches recorded by Innova Market Insights, with cholesterol-reduction products continuing to prevail.

Product developers of functional foods and supplements have a variety of ingredients to consider, as research emerges on their benefits.

New Research on Nuts, Beetroot and Omegas
Pistachios--which may have a greater relative concentration of lutein, beta-carotene and gamma-tocopherol as compared to other nuts--were found in a Pennsylvania State University study to have a healthful effect in adults with high cholesterol. Researchers Colin D. Kay, et al., reported in the June 2010, Journal of Nutrition that just 32-63g of pistachios within a daily fat-controlled diet for four weeks lowered serum-oxidized, low-density lipoproteins concentrations among 10 males and 18 females, as compared to a control diet. This suggests including pistachios in a heart-healthy diet contributes to lowering cholesterol, along with the added benefit of naturally occurring antioxidants.

The anti-hypertensive market remains relatively limited. However, beetroot juice shows some promise for blood pressure-lowering benefits, report researchers from the Queen Mary University of London. Their study found blood pressure was lowered within 24 hours in people who took nitrate tablets, as well as in people who drank beetroot juice; this finding potentially paves the way for a natural approach to lower blood pressure, which also reduces heart disease and stroke risk. "We showed that it is the nitrate content of beetroot juice that underlies its potential to reduce blood pressure. We also found that only a small amount of juice is needed, just 250ml, to have this effect, and the higher the blood pressure at the start of the study, the greater the decrease caused by the nitrate,” said Amrita Ahluwalia, professor of vascular biology at the William Harvey Research Institute.

While some research lends itself to foods poised for explicit heart-health positioning, there are many other foods where the benefit may be implied through the use of ingredients perceived by consumers to be heart-healthy, such as omega-3 fatty acids. A University of Alabama study examined the association of fatty fish, marine omega-3 and heart failure among Swedish women with no heart failure or myocardial infarction history for nine years. The conclusion was that 1-2 servings of fatty fish weekly and marine omega-3 fatty acids were associated with a lower rate of hospitalization from first-time heart failure or death. 

In a sample of mainly male coronary artery disease outpatients, those who had higher omega-3 fatty acid blood levels had an associated lower rate of shortening of telomere length, a chromosome marker of biological aging. "These findings raise the possibility that omega-3 fatty acids may protect against cellular aging in patients with coronary heart disease," concluded Ramin Farzaneh-Far, M.D., of the University of California-San Francisco.

Grains of Truth
In terms of heart-health product categories, the bakery and cereals sector dominates, with over a quarter share of the total. Research investigating whole grain and its cereal fiber, bran and germ components relative to heart disease among U.S. women with type 2 diabetes followed 7,822 individuals in the “Harvard School of Public Health Nurses’ Health Study.” Bran intake was inversely associated with death from heart disease mortality.

 Whole-grain, ready-to-eat oat cereal containing viscous fiber within a weight-loss diet had favorable effects on fasting lipid levels among overweight and obese adults, along with improving other cardiovascular disease risk markers. Researchers Maki KC, et al., published in the February Journal of the American Dietetic Association, reported results of reduced low-density (or “bad”) lipoprotein (LDL) cholesterol were greater than a dietary program alone. Two daily servings of the cereal contained 3g of oat b-glucan, as part of a calorie-reduced diet. Compared to the control diet, there was a greater decrease in waist circumference (another heart disease risk), and, also, the larger LDL, non-high-density lipoprotein cholesterol levels and waist circumference reductions were evident within four weeks.

Brown rice might have an advantage over white rice by offering protection from high blood pressure and atherosclerosis, reports the Temple University School of Medicine. New research suggests the subaleurone layer of Japanese rice--located between the white center of the grain and the brown fibrous outer layer--is rich in oligosaccharides and dietary fibers that are stripped away when brown rice is polished to white. However, it is preserved in half-milled (haigamai) or incompletely milled (kinmemai) rice, two varieties popular in Japan. Many Japanese believe these rices are healthier than white rice, and they may work against the activity of a protein known to induce cardiovascular disease (CVD). This may also help explain why fewer people die of CVD in Japan, where most people eat at least one rice-based dish per day.

“Our research suggests that there is a potential ingredient in rice that may be a good starting point for looking into preventive medicine for cardiovascular diseases,” said Satoru Eguchi, M.D., Ph.D., associate professor of physiology at the Cardiovascular Research Center and Department of Physiology at Temple University’s School of Medicine. “We hope to present an additional health benefit of consuming half-milled or brown rice as part of a regular diet."

Other products comprising the healthy arena include dairy with 12%; ready meals and meal components with 10%; and soft drinks with 9%. Significant numbers of heart-health launches are also found in hot beverages; meat, fish and eggs; fruit and vegetable products; and soups, sauces and seasonings. “The heart-health market seems set for further development over the next five years,” notes Innova Market Insights’ head of research, Lu Ann Williams. “Factors at work include pricing, regulatory, industry and supplier issues.”

Micro-parts for the Heart
The use of antioxidant ingredients for heart health is another area that is relatively undeveloped and may have the potential to go further, particularly using the intrinsic benefits of products such as cocoa and fruit. A study presented at the World Congress of Cardiology Scientific Sessions held in Beijing, China, in June, showed people with decreased micronutrient intake have a significantly higher risk of coronary heart disease, stroke and heart failure. Decreased micronutrient intake was associated with a 1.4 times higher risk of death from cardiovascular disease in white Americans, 1.3 times higher in African-Americans and 1.6 times higher in Mexican-Americans. “This study is the first to demonstrate that multiple micronutrients have significant predicting effects on the risk and all-cause mortality among white Americans and minority populations,” said Longjian Liu, M.D., Ph.D., FAHA, associate professor of epidemiology, Drexel University School of Public Health. “These data suggest that people should ensure they are maintaining healthy micronutrient levels to help reduce their future risk.” Micronutrients are crucially involved in regulating heart function processes related to inflammation, a major determinant of coronary heart disease, stroke, heart failure and heart-related complications in kidney disease and diabetes.

The Heart of a Woman
The opportunities for gender-specific efforts are ripe, as women account for only 20-25% of patients enrolled in most heart disease clinical trials. In “Representation of Women in Randomized Clinical Trials of Cardiovascular Disease Prevention,” published in the March 2010, Circulation: Cardiovascular Quality and Outcomes, authors from the Duke University Medical Center concluded: “Enrollment of women in randomized clinical trials has increased over time, but remains low relative to their overall representation in disease populations. Efforts are needed to reach a level of representation that is adequate to ensure evidence-based, sex-specific recommendations.” Some 60% of younger women between the ages of 20-39 have one or more of these risk factors. Recent data show high rates of overweight/obesity in younger women, which may lead to higher rates of heart disease in later years. “Women are developing heart disease at younger ages, and our research shows that many women, particularly at younger ages, still do not recognize their personal risk,” says Susan Shurin, M.D., acting director, National Heart, Lung and Blood Institute. “What young women need to realize is that leading a healthy lifestyle in their 20s and 30s sets them up for a long and healthy life.” Such a plan would incorporate heart-healthy eating, in combination with regular exercise and medical check-ups.

Kashi and’s survey of nearly 5,000 “health-minded” American women found that almost 60% are very concerned about their heart health and suggests 77% know they are at risk for heart disease. However, over half of those who never look for heart-healthy foods say they do not know how to find these foods.

“What this survey told us is that there are many women who have heart-health concerns and are generally unsure of how they can do more for their heart,” said Keegan Sheridan, natural food and lifestyle expert at Kashi. The survey found the older population to be more conscious of heart-healthy foods than the younger population, with 49% of respondents 55 years old and older looking for foods that support heart health; this is compared to only 32% who are under the age of 55 doing the same, causing concern for today's younger generation. “These figures showed us that younger generations, in particular, are not proactively looking for heart-healthy foods, because they cannot find them, or they are unsure of what to look for,” concluded Sheridan. NS

Lauren Swann, MS, RD, LDN, is a freelance writer and president of Concept Nutrition Inc. (Bensalem, Pa.), which offers consulting services specializing in food labeling, nutrient analyses, marketing communications and cultural dietary practices. She can be reached at 215-639-1203, or

* -- Type in “heart health,” “CVD,” “stroke” or “diabetes” for many articles on these subjects
* -- 2010 study reported in Archives of Internal Medicine finding women who eat a great deal of  high glycemic index (GI) carbohydrates have increased risk of heart disease, while men do not
* -- The Mayo Clinic’s advice for a healthy heart