The heart of the matter

With one in five Americans suffering from some form of coronary vascular disease, the market for heart-healthy foods, beverages and supplements is booming. A Elizabeth Sloan reports on the latest trends.

Heart health is in the headlines like never before with a constant stream of media reports highlighting rising levels of cardiovascular problems linked to obesity and unhealthy lifestyles. In response, an unprecedented number of people in the US are taking measures to lower cholesterol and consume heart-healthy products. And marketers are responding with a wide range of supplements, foods and beverages designed to support heart health.

This growing interest is reflected by the changing behaviour of US consumers, according to the Natural Marketing Institute (NMI). Two-thirds of adults say they?re trying to eat heart-healthy foods, four in 10 have made dietary changes to lower cholesterol and 41 per cent of adults have tried to limit their intake of trans fatty acids in 2003. Low-fat foods topped the list of cuisines consumers said they were going to eat more of in 2004, followed by high-protein, low-carb foods.

Heart-health supplements have enjoyed exceptional growth. The Nutrition Business Journal (NBJ) reports that in 2002, fish oils/omega-3, and essential fatty acids enjoyed the largest sales gains in the speciality supplements category, growing by 32 and 17 per cent, respectively. In 2003, they ranked second in overall sales among speciality supplements just behind glucosamine products and followed by coenzyme Q10.

NBJ reports sales of blood pressure and cholesterol-lowering supplements each grew nearly 18 per cent, with 88 per cent and 67 per cent of respective sales made in traditional channels. The number of Americans purchasing vitamin supplements that have been linked to heart health also has risen. According to NMI, sales of B-complex rose 7.8 per cent, omega-3s 13.8 per cent and fish oils 8.8 per cent in 2003.

Prevention and treatment
Heart disease topped the list of projections for the fastest-growing health conditions in the US between 2003-2013 for both men and women. American Heart Association (AHA) statistics, published in January 2004, confirm that one in five Americans already has some form of coronary vascular disease (CVD). Some 50 million people suffer from high blood pressure; 109 million people have cholesterol levels greater than 200mg/dL; and 41 million people have levels greater than 240mg/dL. Because of this, products aimed at risk reduction are finding a welcome market.

With such a widespread incidence of CVD, it?s also not surprising that the emphasis is shifting from prevention to treatment. (See graph on p. 18.) Many Americans are now treating themselves or a member of their household for a variety of cardiac conditions. In addition to weight, cholesterol and fat, 30 per cent of people are also trying to reduce their salt intake, 28 per cent are trying to treat hypertension and 17 per cent are battling heart disease.

Several new cardiovascular market segments are rapidly emerging. As consumers struggle with the adverse side effects of cholesterol- and blood pressure-lowering prescription drugs, they are seeking more natural solutions. For example, one reason for the high incidence of leg cramps is the use of statin drugs. With IMS Health reporting that cholesterol and triglyceride reducers reached sales of $16 billion in 2003, the potential for safe and effective foods is tremendous. A cost analysis commissioned by Agriculture and Agri-Food Canada with the University of Guelph estimated that functional ingredients could save $6 billion annually in direct costs and $12 billion in indirect costs in treating CVD, hypertension and strokes.

Understanding grows
With media coverage of both heart health and dietary fat at fever pitch, Americans are becoming keenly aware of other important components in blood lipid management. With half of all US men and 41 per cent of women having undesirable LDL levels (greater than 130mg/dL of ?bad? cholesterol) and 20 per cent having under-desirable levels of HDLs (less than 20mg/dL of ?good? cholesterol), products and ingredients that target these risk factors are in high demand.

According to the AHA, twice as many women died of CVD as from all forms of cancer, so women are expected to take more preventative measures in the future. While male deaths from CVD have declined over the past two decades, women?s deaths have risen slightly. Public attention is also increasingly focusing on children with the news that 10 per cent of all US children have cholesterol levels greater than 200mg/dL, and 27 million have levels greater than 170mg/dL ? the traditional risk level for children.

Perhaps of most importance to the industry is the creation of a new at-risk category—?pre-hypertension?—defined in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. This new classification includes people with blood pressures of 120-139mm Hg systolic and 80-89mm Hg diastolic. It is a precursor to chronic high blood pressure.

The guidelines also state that in those aged 50 and over, systolic pressure greater than 140mm Hg is a more important CVD risk than diastolic blood pressure.?They recommend those people who fall into this category be treated regardless of the ?bottom number.? They also suggest most hypertensive patients will require two or more antihypertensive medications to achieve a target blood pressure less than 140/90mm Hg or less than 130/80mm Hg for those with diabetes or chronic kidney disease.


The food industry responds
To help combat this array of problems, US formulators are armed with many new ingredients, in addition to well-known foods such as oats and soy.

In the past year, the Food and Drug Administration has approved cholesterol-lowering health claims for plant sterols, nuts and whole grains, and formalised an existing claim for omega-3 DHA/EPA; the US patent office has cleared heart-healthy claims for rice bran. Meanwhile, the number of consumers who associate food components with heart health continues to grow. (See chart below.)

With the FDA imposing trans fat labelling by January 2006, suppliers have been quick to offer trans fat-free solutions. ADM has developed its Novalipids portfolio of zero and low-trans oils for foods; Cargill offers TransEnd Trans-Free Shortenings; Danisco has trans-free Benefat for baked goods, cereals and snacks; Loders Croklaan sells SansFree Shortening; and the Arnhem Group offers a ?cholesterol-free fat.?

To improve taste as well as fat profile, Watson Foods supplies UltraCel, which mimics the creamy mouthfeel of high-fat foods, and National Starch offers low-fat Dry-Tack 250, a binder that helps seasonings and seeds adhere to snack products.

Davisco?s BioZate1 is one of the first ingredients to lower blood pressure. With an approved heart-friendly health claim, plant sterols and stanols, such as Raisio?s Benecol, Cargill?s CoroWise phytosterols and Cognis? Vegepure vegetarian plant sterol esters are fast gaining attention. Prebiotics, such as Orafti?s Raftilose oligofructose and Raftiline inulin, as well as Imperial Sensus? Frutafit, can reduce serum triglycerides. RFI Ingredients? OxyPhyte heart blend includes four polyphenolic ingredients, while Flavonoid Technologies? bioflavonoids offer another cholesterol-lowering option.

High beta glucan Nutrim oat bran from Futureceuticals and Nurture?s OatVantage provide a highly concentrated form of oat bran for cholesterol/triglyceride lowering and reduced fat absorption. With 85 per cent soluble fibre (dry weight), TIC Gums? GuarNT also performs similar functions. New fibres from locust beans and guar gums, alpha cyclodextrin—an acacia extract with bifidogenic properties—and fibre derived from the bamboo plant are other new heart-healthy ingredient options.

At the same time, major soy marketers, including ADM?s NutriSoy, the Solae Company?s Solae, Cargill?s AdvantaSoy and Acatris? SoyLife, have developed a variety of customised applications.

But when it comes to foods, this year will likely see fish oils move centre stage. About a third of all adults believe their diet is deficient in omega-3s, reports NMI. Nearly half of consumers say they have heard about omega-3 fatty acids, according to HealthFocus, and 59 per cent want to learn more about omega-3s and heart health. Consumer awareness has jumped to 73 per cent for fish oils and 58 per cent for omega-3s, while one in four said they would be interested in trying a food or beverage fortified with omega-3s, reports a Gallup/Multi-Sponsor survey for DSM Nutritional Products.

Among the most recent fish oil product introductions in North America is Quebec-based dairy Natr?l?s Omega-3 nutrient-enriched milk beverage in Canada and GFA Brands? Smart Balance in the US, which is a sterol-enriched spread with omega-3 fish oils. Houston-based Omega Protein has broken new ground by securing a contract to provide 38 school districts in Texas—in conjunction with school meal provider H&H Foods—with omega-3 fortified meals in an effort to improve mental focus and academic performance.

Around 40 per cent of Americans say that labels carrying the claims ?may reduce the risk of heart disease? and ?helps to maintain healthy cholesterol levels? are extremely/very important. Coca-Cola?s Minute Maid cholesterol-lowering HeartSmart juice contains plant sterols and is at a comparable price to other products in the company?s juice range. At rival PepsiCo, the Tropicana brand has been expanded with the Essentials line, which includes Pure Premium Essential Healthy Heart with potassium, vitamins B6, B12, C and E, and folate. It is also sodium-free. The line also features Tropicana Light ?n? Healthy with one-third less sugar and calories than orange juice, a full day?s supply of vitamin C and a supply of calcium.

One of the hottest developments is the use of rice bran products to beat heart disease. The US patent office has recently given the green light to a ?notice of allowance,? clearing 20 claims for NutraCea?s RiSolubles and RiceMucil products. Under the application, the products can claim to ?inhibit platelet aggregation and HMGCoA reductase activity,? as well as dissolve ?aortic streaks?—as a result reducing the risk of cardiovascular disease in both humans and animals.

The future for heart-health products looks bright. Soy protein, dietary fibre, omega-3/fish oil, whey protein, high oleic fatty acids and folic acid, ranked 1, 3, 4, 6, 7 and 10, respectively, in the top 10 list of ingredients that US food industry R&D executives think are most likely to grow their businesses in the next few years.

And, with physicians and pharmacists now the top source of consumer nutrition information in the US, it is comforting to know that 80 per cent of physicians feel that omega-3 supplements are very/somewhat effective in treating heart disease. Just over 60 per cent said the same of vitamin E, 35 per cent believe co-Q10 is effective, while lutein got an approval rating of 34 per cent.

Nearly two-thirds of pharmacists believe fish oils lower cholesterol, 53 per cent believe they prevent heart disease and 42 per cent think they lower triglycerides.

A Elizabeth Sloan is president of Escondido-based Sloan Trends & Solutions in California. Email: [email protected] Correspondences will be forwarded to the author.

Awareness of disease prevention on rise

Top 10 conditions Americans want to prevent

Per cent of households concerned with prevention

Per cent change from 2002 to 2003




Vision problems



Heart disease



High cholesterol












Stress-related problems



Lack of energy






Top 10 conditions Americans are treating

Per cent of households treating/managing

Per cent change from 2002 to 2003

Weight loss (for appearance)



Cholesterol level



Weight loss (for health)



Joint pain/stiffness



Back pain






Fat intake



Sugar intake






Acid reflux



Based on a randomised mail-home survey of 2,000 primary grocery shoppers from the general population. Margin of error plus or minus 2 percent.

Source: The Health & Wellness Trends Database ?The National Marketing Institute, 2003

Ingredients associated with heart health


Per cent of general population that associates nutrient with heart health





Whole grains


Fish oil




Flax seed oil








Based on a randomised mail-home survey of 2,000 primary grocery shoppers from the general population. Margin of error plus or minus 2 percent.

Source: The Health & Wellness Trends Database ?The National Marketing Institute, 2003

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