Circulatory system diseases account for 31% of male and 36% of female deaths in the U.S. Some U.S. cereals have been repositioned to emphasize their beta-glucan and/or whole-grain contents and the related cardiovascular health benefits that can be obtained.

Despite considerable interest, continuing product and promotional activity, and the fact that it is the largest sector of the functional foods market after digestive/gut health, the cardiovascular health or heart benefit sector remains relatively small. This is especially true, when considered within the context of the food and drinks market as a whole. This sector offers considerable potential for future development, although the target audience is likely to remain largely limited to those who perceive themselves to be at risk from cardiovascular disease (CVD).

The market is also very fragmented, consisting of a whole range of products, varying from existing repositioned and reformulated brands within large and mature segments, such as breakfast cereals, to small sectors made up of products containing relatively new ingredients, such as phytosterols and bioactive peptides. In general, growth in the new markets is much faster, as it is from such a small base. However, this sector necessitates high levels of investment in product development and promotional activity/consumer education.

Interest in Foods Dependent on CVD Risk
Diseases of the circulatory system (including coronary heart disease and stroke) account for 31% of male and 36% of female deaths in the U.S. A key factor in the growth of interest in cardiovascular health foods is the rising consumer interest in the role of diet in health, generally, and a desire to take a more active role in promoting and optimizing personal health and well-being. Within the cardiovascular health area, consumers tend to know they or their partner may be at risk and are more likely to want to take responsibility for minimizing that risk as much as possible, including through diet.

The launch of food and drinks marketed on a specific cardiovascular health platform is increasingly allowing consumers to choose more heart-healthy options. At the same time, active educational and promotional initiatives from food and drink companies have increased awareness and allowed the development of heart-health products and brands.

The use of familiar and trusted brands has also been key to the development of the market, with the U.S. breakfast cereals market, in particular, seeing a major repositioning of existing products to emphasize health benefits. Quaker Oat cereals and General Mills’ Cheerios, for example, have been repositioned to emphasize their beta-glucan and whole-grain contents, respectively, and the related cardiovascular health benefits that can be obtained.

Another successful strategy has been the introduction of sub-brands under existing healthy umbrella brands, giving consumers a brand that is already known and associated with health. For example, Unilever, while repositioning its existing polyunsaturated spread brands on a high-omega-fatty-acid heart-health platform, has also introduced its Activ sub-brand on a cholesterol-lowering platform. Additionally, it has extended it into non-spread areas, particularly the dairy sector, for a range of milks, spoonable yogurts and active health drinks.

Market Size and Structure
In different countries around the world, the cardiovascular health foods market varies in its make-up, reflecting the different legislative frameworks in place and use of health claims.

The market for foods making a heart benefit claim in the five key European countries of France, Germany, Italy, Spain and the U.K. was valued by Leatherhead Food Research at $2.61 billion in 2009. Most of these markets are dominated by cholesterol-lowering margarines, and initial high-growth rates in the market have stabilized in recent years, although the small segment of active health drinks has been showing promise. Regulatory issues are proving to be fundamental to the future development of the European market. Winners from the current European Foods Safety Authority assessment process on nutritional claims have included plant sterols/stanols gaining approval for cholesterol reduction, as well as one patented bioactive tomato extract for its anti-thrombotic properties (Multiple Marketing in the UK has launched the Sirco fruit juice brand, which contains this proprietary extract).

In the U.S., there is a larger market of $7.18 billion of foods making cardiovascular health claims, reflecting use of FDA-approved structure-function claims relating to whole grains, soy and oats in a number of sectors, particularly cereals, bread and soy milk. There has also been some growth in heart-health soft drinks, plus the development of a relatively immature fats and oils sector, and a very fragmented dairy sector in this area.

Meanwhile, the Japanese market is entirely different in nature from other countries and regions, but it has a large number of cardiovascular health products in most sectors of the market, most of which do not make claims. The market value for just FOSHU (Foods for Specified Health Use)-approved foods with cholesterol-lowering and blood pressure claims is a modest $572 million. In reality, because of the widespread use of a range of heart-health ingredients throughout the food and drinks industry, the Japanese market can be considered the most developed in the world.

In terms of product type, cereal products dominate, with just over one third of the total market for products making heart-health claims, much of which is accounted for by the very large U.S. market, ahead of fats and oils and fish and eggs, with just over 14% each. Bakery products take fourth place and are also dominated by the U.S. While the U.S. dominates in cereals and bakery, it is Europe that leads in the fats and oils and dairy sectors, with the UK and France particularly strong in yellow fats and Spain in dairy products.

Key growth areas have been bakery and cereal products, largely due to the growing use of heart-health claims relating to whole grains in the U.S.; fish and eggs, due to the increased marketing of oily fish on a heart-health platform; dairy products, where the active health drinks market has taken off; and soft drinks. (See chart “Foods Positioned for Heart Health.”)

Growth Areas in Heart Health and Future Market Developments
Products for cholesterol reduction have continued to dominate, in terms of new launches, while circulatory health foods, dominated by omega-3 products, have seen less activity. This is not the result of fewer items being launched, but more likely the case that other claimed health benefits are being used to target different and broader markets. The anti-hypertensive market remains relatively limited to date, as does the use of antioxidant ingredients for heart health.

The principal cardiovascular health ingredients being used are those where scientific evidence of their efficacy is strongest. These include soy, unsaturated fatty acids (including omega-3s), phytostanol and phytosterol esters, dietary fiber, vitamins C and E, folic acid and potassium.

There is a host of other up-and-coming heart benefit ingredients, in-cluding carotenoids, B vitamins, garlic, polyphenols and flavonoids, and magnesium. In most cases, more research is needed to establish a clear benefit of adding them to functional foods. Less well-proven heart benefit ingredients include conjugated linoleic acid, plant lignans, rice bran oil, coenzyme Q10, betaine and selenium. Further research is needed on these, before any likely protective effects on coronary heart disease can be confirmed. Nonetheless, there has been some product activity featuring most of these ingredients, although the claims situation remains very hazy.

Using recent patent activity as a guide to future trends, it is clear that phytosterols and phytostanols remain a particularly active area, following the acceptance of products, such as Benecol and Promise Activ Super Shots, into the mainstream. Patent applications are largely for technological improvements to plant sterols and stanols, or to make them suitable for inclusion in a wider range of products, particularly drinks.

Another significant growth area is likely to be that of anti-hypertensive products containing bioactive peptides. A number of products are now on the market, but most focus either on a proprietary, cultured milk ingredient used by Calpis in Japan or on a tripeptide said to inhibit a blood pressure-increasing, angiotensin-con-verting enzyme that is used by the dairy company, Valio of Finland. A greater variety of products is likely to be launched in the future, using more diverse sources. Japan, as usual, has featured other more novel ingredients, such as sardine peptides, tomato vinegar and GABA.

Scientific research is also gradually discovering which components of fruit and vegetables are responsible for their various health effects. Consequently, the number of patents relating to the use of these ingredients in convenient heart-health-targeted products is increasing, with particular interest in polyphenols from sources such as cocoa or green tea. The range of soluble fibers used for cholesterol-lowering also appears to be widening, while patent activity relating to soy protein is growing, as well.

The use of beta glucan-delivering oats, which can be viewed as a more “natural” heart-health ingredient and is, thus, very much “on-trend,” also can be expected to increase, as can the marketing of chocolate on a heart-health platform. At the moment, the antioxidant-rich flavonals in dark chocolate are mainly promoted on a multi-benefit platform. For example, Saiwa in Italy has recently launched Oro CereaCol biscuits, featuring beta-glucan from oats and omega-3 to reduce cholesterol “naturally.” Meanwhile, Germany’s Stollwerck has introduced Apotheken chocolate bars made with a branded cocoa, which is high in antioxidants to combat free radicals. They are marketed as aiding blood flow and circulation, healthy cholesterol levels, and a healthy heart and cardiovascular system.

High levels of investment, development and promotion have not always brought the desired result, and there continue to be notable failures. The early mistakes made with cardiovascular health ranges, such as Novartis’ Aviva in Europe, have not been repeated, in that no more major, across-the-board multinational ranges of this nature have been launched. However, there have been national initiatives, such as Barilla’s Alixir functional range in Italy, which incorporate a heart benefit food and drink sub-sector. Otherwise, cardiovascular health food ranges have tended to focus on just one or two major product sectors, particularly dairy products and spreads. It can be noted there have been numerous individual brand failures, both overall and in specific countries. Reasons for this relatively high failure rate are many and varied, but there are a number of recurrent themes, including lack of consumer understanding, lack of product differentiation and resistance to the higher prices involved.

The market seems set for further growth over the next five years, although overall growth rates will depend on various factors, not least legislative. Assuming the claims situation does not undergo radical change resulting in the repositioning of certain products away from cardiovascular health, particularly in the U.S., overall sales in the sector look set to rise at least 40% between 2009-2014, to reach over $15.1 billion. (See chart “Predicted Growth.”) pf
The information in this article is taken from the Leatherhead Food Research report, “The Market for Heart Benefit Foods: 3rd Edition.” To purchase the report, visit and click on the report titled, “The Market for Heart Benefit Foods and The Market for Anti-aging Foods.” 

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