Catering to Cardio Concerns

by Lisa Schofield | January 4, 2022

Although immunity stole the spotlight the past two years, heart health concerns have risen too. It’s a perfect time to emphasize cardiovascular wellness.

Health and disease are at the forefront of fears for people across the globe, which is fortunate for the dietary supplement industry and for individuals who are devoted to taking control of their health through natural means.

Within this, cardiovascular function is a growing focus. “Concern for heart health has grown over the last couple of years, in part because of an increase in heart-related medical emergencies since the beginning of the pandemic,” observed Morris Zelkha, CEO and co-founder, TriNutra, Israel. “Even more troubling is that heart health issues have been connected to the higher-risk symptoms associated with COVID.”

He added that as 2022 dawns fresh with a new variant—omicron—we are entering the third year of this pandemic and all the financial, psychological and health consequences associated with it. Therefore, targeted efforts including supplements to help consumers reduce stress and anxiety, achieve healthy weight, and to improve overall wellness are key to helping them proactively manage their heart health in 2022.

“As we enter our third year of the pandemic, consumers are beginning to remember that there is more to do than focus on immune health,” emphasized Bente Jeanette Foss, CTO, GC Rieber VivoMega, Norway. With cardiovascular challenges still being one of the leading health problems in the U.S., and as concerns around COVID-19 continue to decrease as vaccinations become more common, Foss expects heart health to continue to grow over the next few years.

Therefore, she stated, “It’s vital that heart health supplements are linked to lifestyle efforts, that natural product companies help consumers recognize that the supplements they take for their heart have a crossover effect on other aspects of their lives.” GC Rieber VivoMega, she noted, is promoting this through its sampling program that showcases how its omega-3 concentrates can support immune, brain, bone and joint health in addition to its commonly recognized heart health benefits. “This multi-functional approach will help improve heart health as part of an effort toward overall improved wellbeing,” she commented.

Rob Brewster, president, California-based Ingredients by Nature (IBN), California, echoed this concept. “Displaying cross functionality, such as with immune health and heart health, will definitely catch more attention over the next couple of years than ingredients that are marketed to only benefit the heart.”

Also in agreement is Zev Ziegler, head of global brand and marketing, health, Lycored, New Jersey, who pointed out that heart health is right at the top of the consumer agenda. Cardiovascular disease affects the majority of people over the age of 60 to some degree and, along with diabetes, is the biggest health concern for older men in the West, according to Lycored data (“Diabetes and Cardiovascular Disease are Top Health Fears for Older Men,” 11-12-2018).

Lycored’s market research (Lycored ‘Calm: The new concept at the heart of cardiovascular wellness,’ 2020) shows that 68 percent of consumers rank healthy blood pressure as one of the three CVH (cardiovascular health) goals they most want to achieve, ahead of healthy blood cholesterol levels (61 percent), healthy arteries (55 percent) and a healthy circulatory system (45 percent).

A few years ago, NattoPharma conducted a survey of 380 dietary supplement consumers asking to identify their most important health concerns. “Not surprisingly heart health ranked amongst the highest concern,” related Eric Anderson, vice president NattoPharma/Gnosis by Lesaffre, New Jersey. “I doubt that this has changed very much, as most surveys put cardiovascular health in the top concerns.”

Interestingly, it appears that consumers are starting to understand that supporting their hearts is not an isolated activity. Explained Ziegler, “Consumers have never been more aware that physical, emotional and cardiovascular wellness are closely related. Even before the pandemic, our research (Lycored ‘Calm: The new concept at the heart of cardiovascular wellness’, 2020) found that 48 percent of U.S. consumers had made attempts to increase their levels of calm to protect their cardiovascular health,” he reported. Also, 43 percent of respondents indicated they would be more likely to buy a cardiovascular health product if its branding or packaging included the word “calm.” In other words, Ziegler concluded, “manufacturers of heart health products could consider shifting their value proposition from a negative (the avoidance of risk) to a positive (the promotion of daily calm).”

Indeed, offered Zelkha, products that are targeted for heart support should include ingredients that reduce stress, have high antioxidant capacity, support healthy anti-inflammatory processes, and also ingredients that have a positive net effect on immune system function. Here’s why, he explained, “Stress promotes the generation of reactive oxidation species which leads to oxidative stress which then leads to inflammation, all signs of an unregulated immune response. These products should also have components that are able to help control psychological distress. Formulators should aim to create products that control cortisol levels (the stress hormone), promote healthy blood pressure, and that support a healthy circadian rhythm for a good night’s sleep.”

Annie Eng, CEO, HP Ingredients, based in Florida, concurred. “Controlling stress is critical to protecting cardiovascular sufficiency. Stress, especially long-term stress, causes individuals to seek comfort in foods that elevate cholesterol, and also increases fat and weight. Stress impacts heart health in many ways.”

At first blush, formulating with all this in mind may be daunting, but it doesn’t have to be, according to Foss. Seek out high-potency ingredients that should result in smaller doses or fewer pills, which is appealing to more consumers. As an example, she offered, GC Rieber is developing higher concentrate omega-3 oils with VivoMega to enable high EPA (eicosapentaenoic acid)/DHA (docosahexaenoic acid) applications in a smaller pill to promote dose regimen compliance, which can improve results from omega-3 consumption. She reminded, “Many seniors often take half a dozen medications per day, so VivoMega can help reduce the number of combined pills from medications and supplements that they need to take.”

One common concern among adults in their late 30s, early 40s and older is blood pressure, so adding an ingredient that helps consumers to address this number should be a consideration, according to Derek Tobin, PhD, business development and clinical science manager, Epax Norway AS. “There have been numerous controlled clinical studies that validate the positive effects of omega-3 on heart health and on maintaining healthy blood pressure,” he underscored.

As an example he offered, a meta-analysis looking specifically at the effects of EPA and DHA on blood pressure found that across 70 randomized controlled trials, there was a reduction in systolic blood pressure for all of those given EPA and DHA, compared with the placebo. The strongest effects of the omega-3 supplementation were observed among the untreated hypertensive subjects.

Cholesterol, stress effects and blood pressure—all are cardio related. Therefore, “Manufacturers should consider developing products that deliver cross-functional benefits,” Zelkha asserted. “By using ingredients that contribute to a wide range of health performance outcomes, products will be more attractive to today’s consumer that is seeking multi-faceted benefits from products for overall wellbeing.”

He added that other factors that may warrant consideration in new cardio-oriented formulas are a anti-viral activity, innate and adaptive immune system support, effect on mitochondrial function, and stress or anxiety adaptogens that can help manage healthy cortisol levels, allowing the brain to relax and thus for the consumer to experience a calm, mindful decision-making mindset. “It is a lot, but we now understand that our health categories aren’t as simple as they seem,” he commented. “Different physiological systems work together and affect each other. Therefore, to launch a comprehensive and efficacious heart health supplement, it makes sense to also incorporate ingredients that have tangential benefit to cardiovascular health through their influence on supporting health systems.”

Brewster agreed, adding that ingredients that not only help consumers manage cholesterol and triglyceride levels, but also helps to support blood glucose maintenance, will deliver extra value. “There are other opportunities in heart health to grab consumer attention by highlighting how the ingredient provides more holistic support toward overall wellness,” he said.

Heart Health Ingredient Considerations

Perhaps the most well-known ingredients for protecting cardiovascular function are DHA/EPA (omega-3 EFAS [essential fatty acids]). For example, a 2021 study published in Mayo Clinical Proceedings concluded that EPA and DHA consumption is associated with reduced risk of coronary heart disease and of myocardial infarction. Further, the researchers found that cardiovascular benefits appear to increase with dosage; with each 1 g of EPA and DHA daily decreasing the risk of cardiovascular disease by 5.8 percent and heart attack by 9 percent, reported Tobin.

Epax offers triglyceride (TG) and ethyl ester (EE) ingredients; its two main product lines are Epax Ultra Concentrates, which Tobin described as “next generation” omega-3 ingredients guaranteeing a minimum 700 mg/g of EPA/DHA; and Epax Core Concentrates: traditional high-strength, “ultra-pure” omega-3 ingredients. Epax can also create bespoke omega-3 formulas, he noted, and 45 percent of its product range is custom-made.

In 2020, Epax received a Norwegian Research Council award of approximately $918,000 over four years to help conduct further research into the benefits of “new” omega-3 fatty acids. This research will support the wider Epax “Oceans of Possibilities” initiative investigating novel, bio-active marine products. Ultimately, it will also be the foundation for the first products in the new Epax NovusLipid range, which is currently in development.

Foss elaborated that research has shown that EPA and DHA help to moderate several of the risk factors behind cardiovascular disease, including heart disease through their potential to manage blood pressure, reduce blood triglycerides, slow the development of plaque in the arteries, regulate heart rate, and reduce inflammation.

“Recently, several studies have indicated that the cardiovascular health effect is increased with the continued intake of EPA/DHA omega-3s,” she said. “Highly concentrated omega-3 oils like our VivoMega enable high EPA/DHA applications in a smaller pill, which can increase dose regimen compliance of recommended daily EPA/DHA intake.”

Phytosterols have been making strong inroads in supplements for cardio-care. “Several global studies have concluded that the effective doses of phytosterol for reduction of cholesterol are between 1.5 to 3 g/day, leading to decrease in 8 to 15 percent of LDL-cholesterol,” said Scott Murray, business development manager, North America at Matrix Life Science, Inc. in Delaware. He pointed out that the company’s PhytoLite is currently used as anti-cholesterol additive. It is stable to elevated temperature conditions and their solubility in oils and fats enables its use in various formulations. The enrichment of foods such as margarines with phytosterol esters has been an important development in functional foods to enhance the cholesterol lowering ability of traditional food products.”

Phytolite Phytosterols acts as a fat replacer for the heart health supplement products with additional benefits of being a non-GMO (genetically modified organism) plant source. “One area that often gets overlooked is adding in supplements that address underlying stress for those with elevated blood pressure leading to coronary diseases. Phytolite Phytosterols helps reduce bad LDL cholesterol from the body which reduces the risk of harmful cardiovascular/coronary conditions,” Murray commented.

He added that Matrix Life Science is conducting a trial on healthy volunteers with dyslipidemia. The study is to evaluate the efficacy and safety of Phytolite supplementation in the management of hypercholesterolemia.

Sytrinol from IBN is a proprietary ingredient that combines citrus-derived polymethoxylated flavones with tocotrienols for management of cardiovascular health, according to Brewster. “Our randomized, double-blind, placebo-controlled study on Sytrinol revealed that in as little as four weeks, subjects were able to reduce cholesterol levels by 27 percent, LDL cholesterol by 25 percent, and triglyceride levels by 31 percent.

Brewster added that IBN plans on undertaking a SHIME study on Sytrinol to discover its potential to benefit the microbiome, as well as to explore Sytrinol’s potential synergy when combined with other ingredients, such as looking into a combination of Sytrinol and Eriomin for a greater impact on heart health through prediabetes management.

Another citrus compound with numerous studies is HP Ingredients’ Bergamonte Bergamot Polyphenolic Fraction 100% (BPF), derived from Citrus bergamia Risso from Italy’s Calabrian coast, which Eng said, “improves overall biomarkers of hyperlipemia through reducing serum cholesterol, triglycerides, LDL and small dense lipoproteins, as well as increasing HDL. BPF also helps maintain normal serum glucose concentrations by supporting against insulin-resistance. In this manner, Bergamonte supports heart health by helping to improve cardiometabolic function.”

BPF is the most widely studied extract of the Bergamot fruit’s juice and albedo, which has a unique profile of flavonoids and glycosides, such as neoeriocitrin, neohesperidin, naringin, rutin, neodesmin, rhoifolin and poncirin. These flavonoids are clinically proven to help maintaining healthy cholesterol,” Eng commented.

Recent studies showed that the BPF represents a viable alternative to statins in patients who are intolerant to these drugs or in subjects who discontinue the treatment due to side effects, Eng said. She pointed to a study that compared efficacy of Bergamonte BPF with and without rosuvastatin in 77 individuals with elevated LDL and triglyceride levels. They were randomly assigned to placebo or two groups receiving orally administered rosuvastatin (10 and 20 mg/daily for 30 days), a group receiving Bergamonte BPF alone orally (1,000 mg/daily for 30 days) and a group receiving BPF (1,000 mg/daily) plus rosuvastatin (10 mg/daily for 30 days).

Those with mixed hyperlipidemia taking Bergamonte BPF significantly reduced total cholesterol, LDL, triglycerides and enhanced HDL levels. Association of Bergamonte BPF 1,000 mg with the 10 mg rosuvastatin significantly enhanced the hypolipidemic effect of alone. “In addition, triglycerides were reduced by 42 percent and HDL was increased by 34 percent, an effect which was significantly higher while compared to the use of rosuvastatin alone,” Eng stated.

Other plant-based cardio-support ingredient options include lycopene and black seed oil.

According to Ziegler, Lycored announced that the results of its latest heart health study showed a positive link between its tomato nutrient complex and cardiovascular health. For this double-blind randomized study, 61 participants took either Lycored’s tomato nutrient complex, synthetic lycopene, or a placebo. “The results showed a decrease in blood pressure for those who took our tomato complex, while those who took synthetic lycopene alone showed no change in blood pressure,” he reported.

He added that Lycored’s most recent clinical trial results showed that supplementation with tomato nutrient complex containing 15 or 30 mg of lycopene was associated with statistically significant reductions in blood pressure, but lycopene alone was not. The findings indicate that tomato nutrient complex offers beneficial outcomes for systolic blood pressure but lycopene alone does not drive the same effect.

TriNutra’s ThymoQuin is a full-spectrum black seed oil standardized to 3 percent thymoquinone, the main active constituent of the ingredient. ThymoQuin is standardized to contain less than 2 percent free fatty acid and a minimum of 1 percent P-cymene.

“One study on ThymoQuin revealed its benefits for heart health by regulating systolic and diastolic blood pressure in humans within two days and continued to do so over the course of six to 12 weeks, even after supplementation had been halted,” explained Zehlka. “In our recent, not-yet-published exercise study participants demonstrated that consumption of ThymoQuin supported maintenance of healthy cortisol levels. Exercise stress is similar to other physiological stressors, like psychological stress, and can lead to an increased susceptibility to heart problems and a weakened immune system.”

Heart Healthy Minerals and Vitamins

Potassium and magnesium are powerful, well-researched minerals that the heart needs to function properly, according to Ohad Cohen, chief executive officer, Gadot Biochemicals Ltd., a global expert in minerals based in Israel. “Potassium and magnesium have a direct correlation with cardiovascular events and risk factors, especially with blood pressure,” he said.

Cohen explained that normal body levels of potassium are important for muscle function, including relaxing the walls of the blood vessels. This lowers blood pressure and protects against muscle cramping. Normal potassium levels also are important for the conduction of electrical signals in the nervous system and in the heart, which protects against an irregular heartbeat.

Magnesium, he explained, helps regulate hundreds of body systems, including blood pressure, blood sugar and muscle and nerve function. Humans need magnesium to help blood vessels relax, and for energy production, as well as for bone development.

Gadot Biochemical Industries produces and supplies a range of highly bioavailable minerals for dietary supplements, including potassium citrate, and different grades of magnesium citrate, and magnesium gluconate. Cohen described, “Gadot developed a unique product—Gadomag K, which is a highly dispersible magnesium potassium citrate. Usage of the ingredient provides benefits of both essential minerals, without potassium salt bitterness.”

More recently, Cohen added, there has been research illuminating an impact of the magnesium to calcium ratio on calcification of the aortic wall. Research showed that supplementation with calcium caused vascular calcification and that it can be corrected by supplementing with a defined calcium and magnesium ratio.

An increasing amount of research is demonstrating that adding vitamin K2 to calcium supplements or one’s daily diet/supplement regimen helps prevent calcification in the arteries, Anderson pointed out. “What is very exciting is that there are a number of studies recently completing and ongoing looking at coronary artery calcification, aortic valve calcification and peripheral artery disease, as well as dialysis and kidney transplant patients. These studies are largely financed with public monies and are looking at folks that had significant health challenges,” he commented.

For example, according to Anderson, a MenaQ7 study published in Vascular Diseases and Therapeutics in 2020 with 243 healthy men and women showed a significant improvement in the activation of the vitamin K-dependent protein matrix GLA protein, and a positive impact on pulse wave velocity, a measurement of vascular elasticity. I believe that these trials will have a significant impact convincing traditional physicians to recommend K2,” he stated.

In tandem, the B vitamin, folic acid, is a potent cardiovascular support agent. Quatrefolic from Gnosis by Lesaffre in France offers tangible advantages versus folic acid and can promote healthier heart life reaching better blood levels of folate directly translates to lower homocysteine levels. Folic acid must be first converted into 5-methyltetrahydrofolate, or 5-MTHF, a natural and absorbable form of vitamin B9 by a multi-enzymatic steps process. “Quatrefolic is the biologically active form of folate that completely bypasses this metabolic route,” stated Kate Quackenbush, communications director.

Beyond the obvious—arterial calcification and control of cholesterol and blood pressure—stress and even immunity should be considered in new, novel and relevant cardiovascular support supplements. NIE