Healthy lifestyle factors can prevent it, yet it’s the number one health threat in the world, says Trisha Sugarek MacDonald, BS, MS, Sr. Director of Research & Development at Bluebonnet Nutrition Corporation. She’s talking, of course, about cardiovascular disease, a variety of conditions that affect the heart—from infections to genetic defects and blood vessel diseases.

With 416 Baby Boomers turning 65 every hour, heart health will remain top issue in the years to come, Sugarek MacDonald notes. But it’s not just a concern for the aging population. Taking steps to maintain heart health is important for all ages. As pediatric cardiology specialist Ronald Kanter, M.D., stressed in an article titled “Prevention of Heart Disease Starts in Childhood” on “The kinds of heart problems which relate to the problems adults have don’t really manifest themselves until [children are] much older. But the seeds of those problems are sown in childhood and adolescence.” Obesity, diabetes, a sedentary lifestyle, smoking, and high blood pressure are the “seeds” that set the stage for disease (1).

In terms of prevention, there’s a lot that can be done. “The American Heart Association describes healthy diet as ‘one of the best weapons you have to fight cardiovascular disease,’ and we’ve recently conducted research demonstrating that consumers understand this,” shares Golan Raz, Head of Global Health Division, Lycored. “We surveyed 500 people over the age of 50 and asked them what they saw as the most important ways to promote cardiovascular wellness. Scoring highest was healthy diet, with two thirds (67%) of respondents ranking it top of a list of four factors, ahead of regular exercise at 25%.”

“Diet is where everything should start,” says Cheryl Myers, Chief of Scientific Affairs and Education at EuroPharma, Inc. “Cutting back on inflammatory foods like sugars and refined grains will help reduce the conditions that can lead to arterial damage and the likelihood of plaque formation and blockage. Then, I would consider healthy fats as an integral part of a heart-healthy regimen. That might sound counterintuitive, but because healthy fats make up the flexible and strong cellular walls of arteries and blood vessels, they are absolutely necessary in the diet.” Add to that physical activity—Myers notes that anything from riding a bike, walking around the neighborhood, joining a dance class, or just working in the garden counts. “Doing those things doesn’t just help you exercise your heart,” Myers adds, “it helps you feel psychologically better, too, which is also important.”

Consumers agree: The Lycored survey also revealed that people are consciously trying to introduce calm into their lives. “Four in 10 (41%) overall—and 48% of those in the U.S.— had made attempts to increase their calmness in order to protect their cardiovascular wellness,” Raz adds, noting that consumers see their cardiovascular wellness in very holistic terms. “Six in 10 of our survey respondents agreed with the statement ‘I believe in a holistic approach to cardiovascular wellness, including physical, mental and nutritional elements.’ Similarly, almost all (96%) of them believed that physical, emotional and cardiovascular wellness are either closely connected or somewhat connected.” (For more on ways to cultivate calm, read “Adaptogens: Nature’s Answer to Stressed & Tired.")

“Obviously, changing one’s diet, stress reduction, and exercising are the most crucial interventions, but dietary supplements can be an important complement,” says Neil E. Levin, CCN, DANLA, Senior Nutrition Education Manager at NOW. “Unfortunately, more than half of all sudden deaths from cardiovascular incidents—heart attacks and strokes—cannot be predicted or explained on the basis of known heart disease risk factors and established criteria such as blood pressure, serum cholesterol, smoking, weight, and ECG abnormalities. Something else is happening that modern cardiology can’t explain with all of its tools and tests. Still, the medical establishment largely overlooks nutritional influences on heart health. But nutrients have repeatedly and significantly been shown to play a role in cardiovascular health.”

When it comes to supplements, Raz says, the Lycored survey shows that consumers are willing to invest in quality. “Evidence and naturality are far more important to consumers than price. When we asked consumers which factors were most important to them when buying a supplement for their CVH, over half (54%) ranked ‘It offers benefits that are supported by scientific evidence’ as the most important factor, with ‘It contains natural ingredients’ second at 23%. Both were seen as more important than price.”

Heart-Healthy Checklist

By Leslie Gallo, President, Artemis 

While cardiovascular disease remains the leading cause of death for both men and women, there is some good news: Heart attacks in men are declining. Unfortunately, heart attacks are on the rise in women. According to the CDC, about 1 in 16 women aged 20 and older have coronary heart disease. This is a daunting statistic. And while genetic factors can play a significant role with a person’s risk factor for high blood pressure and cholesterol, there are steps we can take, and things to avoid, to help reduce the risk:

  • If possible, gather information about your family medical history to be better informed of any genetic predisposition to cardiovascular disease.

  • Implement regular physical activity into your daily/weekly routine, especially for overweight individuals, as it helps strengthen heart muscles, increases blood flow, and can help with weight reduction

  • Have your cholesterol checked regularly—LDL (bad cholesterol) should be low while your HDL (good cholesterol that helps protect against heart disease) should be high.

  • Follow a healthy diet that includes a mixture of fruits, vegetables, nuts, fiber, and protein, trying to avoid trans and saturated fats.

  • Have your blood pressure checked annually.

  • If you are a smoker, quit.

In addition, certain dietary supplements can help either in conjunction with prescription drugs or on their own to limit prescription drugs (of course with your doctor’s approval).

2020 category overview “Heart health products have been an integral part of our industry for decades,” says Sid Shastri, M.Sc., Director of Product Development, Kaneka Probiotics. “The market for heart health is nearing the $3 Billion dollar mark; its growth rate is around the same growth rate for the supplements industry, which is about 5% to 6% growth annually.”

For retailers trying to optimize shelf space—as well as consumers trying to make the best choice for their needs—the massive array of offerings presents challenges. “Certainly, the heart health category is a crowded space, for good reason, populated with numerous substantiated ingredients,” says Chris Tower, VP Sales, Artemis International. “Top of mind are cholesterol management ingredients such as soluble dietary fibers, unsaturated fatty acids, omega-3s, stanols and sterols; carotenoid ingredients such as astaxanthin, and lycopene; and powerful antioxidant/capillarotropic ingredients such as CoQ10/Ubiquinol, and various flavonoids/polyphenols (anthocyanins, proanthocyanidins) derived largely from fruits/berries wherein Artemis specializes under our signature Berryceuticals portfolio.”

Levin also spotlights several of those nutrients and adds a few more that are frequently taken for cardiovascular benefits: magnesium, Pycnogenol, hawthorn leaf and flower extract, solubilized grape seed extract, taurine, cayenne, plant sterols, citrus extracts, CoQ10, omega-3, l-carnitine, vitamin E complex, and vitamin K2 as MK-7. “Also,” he notes, “vitamins C and D have profound cardiovascular effects in addition to their other known benefits.”

The more you can differentiate heart health claims, the easier it is to communicate the benefits to consumers, advises Steve Holtby, President & CEO, Soft Gel Technologies, Inc. “‘Supports heart health’ is a broad claim that still is functional in the marketplace, but ‘promotes healthy cholesterol levels’ or ‘supports healthy blood pressure’ are more specific claims that send a powerful message. Manufacturers have to invest in education to get any message across about a certain nutrient or product, for any category. Funding clinical trials or investing in studies lends credibility and provides more scientific support for the professional community as well as consumers. Properly promoting key cardiovascular nutrients requires taking scientific evidence and presenting it to the consumer in a simple, understandable manner.“

At the retail level, Sugarek MacDonald suggests: “Select wide-ranging and appropriate targeted supplements for heart health and divide the heart health product section into subcategories.” The examples she offers:
  • Maintaining low homocysteine levels (e.g., niacin, B-6, B-12, folic acid and trimethylglycine)
  • Supporting blood pressure (e.g., milk-derived tripeptides, cocoa extract, oligonol lychee nut extract, grape seed extract, vitamin C, omega-3, flaxseed proteins, N-acetyl-L-aspartyl taurine, magnesium, etc.)
  • Maintaining healthy cholesterol levels (e.g., red yeast rice, policosanol, pantethine and plant sterols)
  • Supporting healthy triglyceride levels (e.g., omega-3 fish oils rich in EPA)
  • Providing general heart health and antioxidant support (e.g., CoQ10 as Ubiquinol or Ubiquinone, vitamin D3, omega-3 fish oil, flax oil, vitamin E, magnesium, arginine, fiber powder, super fruits like pomegranate standardized for polyphenols and green products like Bluebonnet’s Super Earth Organic Greens Powder)
  • Maintaining a healthy weight (e.g., Garcinia Cambogia, Clarinol CLA, chromium etc.)
Within that, Sugarek MacDonald maintains that it’s best to avoid too much product redundancy. “Focus on one particular heart-health subcategory or pick 3 popular items across the heart-health categories for an overall heart-health approach and then rotate on a monthly basis. For example, provide an endcap with red yeast rice, ubiquinol and omega 3 fish oils, and provide literature that states the heart healthy benefits of each and merchandise accordingly on endcaps or a special ‘heart healthy stand or table.’”

A closer look at heart-healthy heroes “There is no shortage of heart health dietary supplements for consumers to choose from today, but helping them to understand what fits best for their needs is essential,” says Kate Pastor, SVP Superba Sales America, Aker BioMarine Antarctic US LLC. “From ingredient suppliers to retailers and everyone in between, as experts in the natural products industry, it’s our job to help educate the consumers.” To help do just that, we asked our experts to discuss the latest science and their top offerings in the heart-healthy category.

Omega-3 fatty acids “One of the best heart-health supplements is omega-3 fatty acid concentrate from molecularly distilled, high-quality fish oil. No other dietary supplement has as much research demonstrating its benefits for overall health and for heart health, specifically,” asserts Holtby. He adds that his company offers several varieties of fish oil capsules with various potencies of EPA and DHA, including EZ Mega 3 softgels. “The fish oils encapsulated by Soft Gel Technologies, Inc. are molecularly distilled, meet stringent standards and contain natural antioxidants (d-alpha tocopherol) to prevent rancidity. We also test peroxide values, and take great care during manufacturing to ensure the oil is protected from oxidation.”

Offering more insight into the science on omegas, Jolie Root, Senior Nutritionist and Educator at Carlson Laboratories, shares: “It is well established that EPA and DHA reduce triglycerides and blood pressure and even highly critical meta-analyses have found that they reduce cardiac death risk. While the more expensive prescription form omega-3 manufacturers insist that those forms exclusively bring benefit, the omega-3 research community understands that that is marketing but is not consistent with the larger existing body of science. A study published recently in the American Journal of Hypertension found that consuming omega-3 supplements or omega-3 rich food may be as effective in reducing blood pressure as reducing sodium, alcohol or increasing exercise (2). Recently, low omega-3 levels, as measured by a red blood cell analysis called the Omega-3 Index, have been found to be an independent risk factor for cardiovascular disease with those in the highest quintile having a 34% lower risk for death from any cause and 39% lower risk for incident CVD compared to those in the lowest quintile (3).”

The heart and arteries love omega-3 fatty acids, Myers agrees. “They help build strong arterial structures that are also flexible enough to allow for changes in blood pressure and help promote better blood pressure. But that’s only if they can be properly used by the body in the first place.” She contends that the intensive processing necessary to create fish oil supplements can alter the DHA and EPA to the point that they are no longer bioidentical. “In a sense, the processing of fish oil alters the shape of the nutrient ‘key’ so much that it no longer easily fits the lock.”

Europharma’s Vectomega, she says, is made with a patented process that uses just water and enzymes immediately following the catch of salmon. “That means there’s no intensive heat or harsh solvents that damage or alter the natural omega-3s.” She adds that Vectomega features omega-3s that are bound to a spectrum of phospholipids, as with omega-3s from food. “It also includes peptides, so it’s almost like a multiple unto itself.”

Also speaking to the science, Lori Avant, Director of Sales, Retail, at Nordic Naturals, says, “We’re excited to see new research that indicates a 2,000 mg daily serving of omega-3s EPA and DHA can significantly increase an individual’s Omega-3 Index to achieve therapeutic levels in a relatively short period of time. This is especially good news for customers interested in heart health, since omega-3s have long been known to help support overall cardiovascular health. Unfortunately, most Americans consume a diet that’s very high in omega-6 fats and low in omega-3s. Research suggests that this imbalanced intake of essential fatty acids is a contributing factor to a variety of cardiovascular concerns. In line with this evidence, Ultimate Omega 2X—Nordic Naturals’ most powerful omega-3 concentrate—delivers 2,000 mg EPA+DHA in just two soft gels, providing an easy and effective way to help increase the omega-3 index and restore a healthy balance of fats in the body.”

NOW also offers a wide range of safety-tested fish oils, says Levin, including the popular high potency Ultra Omega-3 softgels (500 mg EPA and 250 mg DHA, esterified form) and the Tri-3D Omega softgels (330 mg EPA and 220 mg DHA, reconverted triglyceride form). “We test not only for fatty acids,” he says, “but for heavy metals and other environmental toxins.”

Turning to krill oil, Pastor notes that it also is a clinically researched omega-3 option for heart health, plus provides health benefits for the eyes, liver, skin, brain and more. Krill is naturally bound to phospholipids, preserves itself with astaxanthin in its organically occurring composition and is an ideal source of choline, she adds. “Superba Krill is one of the most researched krill oil brands on the market with several studies documenting its efficiency in raising the Omega-3 Index in the body.”

“Krill oil is the only marine oil that includes a combination of three key substances the human body needs to function properly: omega-3 essential fatty acids (EPA and DHA), phospholipids (an important component of the cell membranes) and antioxidants including astaxanthin (a potent carotenoid that gives krill its red-orange color),” adds Hank Cheatham, Vice President of Daiwa Health Development, which offers Daiwa Krill Oil and Daiwa Super Krill Oil powered by Superba Boost. “Research studies show that krill oil can significantly decrease both diastolic and systolic blood pressure, thereby enhancing cardiovascular health.”

CoQ10 and Ubiquinol Along with omega-3s, Avant points to the power of CoQ10. “CoQ10 is a vitamin-like nutrient that helps your cells generate energy, especially cells in the heart. If you think of your cells’ mitochondria as a tiny engine, CoQ10 is the fuel that powers them.” Formulated with the heart in mind, she says, “Nordic Naturals Ultimate Omega + CoQ10 combines high-potency, concentrated omega-3 fish oil and CoQ10 in one convenient, heart-healthy serving.”

Evidence of the benefits of CoQ10 comes from Soft Gel—the company’s CoQsol, which is an enhanced-absorption soft gel formulation of CoQ10 that includes other antioxidant ingredients such as natural beta carotene and mixed tocopherol, has been shown in clinical research to improve serum levels of CoQ10, and a preclinical trial demonstrated that it was preferentially absorbed into heart cell mitochondria, the energy source for the heart, Holtby says. The company also offers CoQsol-CF, a solubilized form of CoQ10 in a proprietary matrix; Holtby says a pilot clinical trial demonstrated that this delivery system enhances the bioavailability of CoQ10. Another offering: Soft Gel has a patent-pending formula to protect ubiquinol from being oxidized, called CoQH-CF. “This unique soft gel delivery system with Kaneka QH allows individuals who are unable to process CoQ10 effectively on their own—primarily Baby Boomers and those with disorders of elevated oxidative stress—to increase plasma levels of CoQ10 in its reduced form.”

Another important benefit of CoQ10: “Many people with elevated cholesterol take statins to reduce their total cholesterol and their LDL levels,” Root notes. “Statins also reduce CoQ10. Taking supplemental CoQ10 reduces some of the side effects of statins that are probably caused by CoQ10 depletion. An example is this: Statins may interfere with cardiac function, reducing the heart’s ability to efficiently pump blood. Taking CoQ10 can reverse this effect and improve heart function. CoQ10 is beneficial for people with heart failure. A two-year study found that in patients with heart failure, taking 300 mg of CoQ10 daily reduced deaths by 43% (3b). CoQ10 also improves exercise capacity in heart failure patients.”

CoQ10 is also featured in Bluebonnet’s Targeted Choice Blood Pressure Support, which Sugarek MacDonald says is a blend of complementary vitamins, minerals and sustainably harvested or wildcrafted herbal extracts, as well as pharmaceutical-grade amino acids plus CoQ10. The ingredients have been shown to help maintain blood pressure levels already within the normal range through various mechanisms: CoQ10, grape seed extract and taurine offer heart-healthy antioxidant properties; magnesium and hawthorn leaf/flower extract help reduce vasoconstriction; magnesium, arginine and grape seed extract help enhance circulation and blood flow; and hawthorn, hibiscus, olive leaf, grape seed, onion, and pumpkin help decrease hypertensive hormones in the adrenal and pituitary glands.

Vitamin K2 “Cardiovascular problems are typically attributed to diet and lifestyle, such as smoking and inactivity. There are even some who view atherosclerosis / coronary heart disease / coronary artery disease as age-related conditions—that calcification simply builds up over time,” says Kate Quackenbush, Director of Communications, NattoPharma USA, Inc. “In fact, NattoPharma contends that this condition is not simply age-related; rather, that atherosclerosis is the product of a vitamin deficiency. Matrix Gla Protein (MGP) is the most potent known inhibitor of vascular calcification to date. MGP is a K-dependent protein already present in the body, but it needs adequate Vitamin K2 as MK-7 in order to be activated to perform its function.”

Offering more insight into the nutrient’s actions, Quackenbush says Vitamin K2 as MK-7 is unique because it supports bone health while simultaneously impacting arterial calcification. “It does this by helping the body to properly utilize calcium by activating K-dependent proteins already present in the body: Osteocalcin binds calcium to the bone mineral matrix (where it is needed); Matrix Gla Protein (MGP) inhibits calcium from depositing in arteries and soft tissues (where it can increase cardiovascular risks). In addition to being a perfect complement for calcium supplements, it is important to note is that K2 works synergistically with other well-known heart-support nutrients, such as Vitamin D3 and Omega-3s.”

Quackenbush notes that Vitamin K2 as MK-7 has a substantial and growing body of evidence showing it safely and effectively simultaneously supports bone and cardiovascular health. “NattoPharma has been the driver of this research, providing our MenaQ7 Vitamin K2 as MK-7 as the source material.” She notes that there are more than 19 human clinical trials. “The most impactful was our 3-year cardiovascular study of healthy postmenopausal women (4). Scientists performed a double-blind, randomized, intervention study of 244 postmenopausal women given either 180 mcg of Vitamin K2 as MK-7 (as MenaQ7 by NattoPharma) or a placebo daily for 3 years. This first intervention trial on MK-7 supplements and cardiovascular endpoints showed that 3-year supplementation with a daily, nutritional dose of MenaQ7 was enough to actually decrease arterial stiffness in healthy post-menopausal women.” For more on the science, go to

Natto-based supplements “Few truly new ingredients have hit the heart health arena in recent years,” says Jay Levy, Director of Sales, Wakunaga. “Among those that have, however, nattokinase is garnering a great deal of attention. Nattokinase is an enzyme found in fermented soybeans that acts like an ACE inhibitor.” He points to a recent trial of 73 individuals with borderline hypertension published in the journal Hypertension Research. Nattokinase was shown to reduce systolic blood pressure by an average of 5.55 mmHg and diastolic blood pressure by an average of 2.84 mmHg in eight weeks. “What’s more,” says Levy, “preliminary studies suggest that nattokinase improves blood viscosity and reduce the risk of developing blood clots. Nattokinase can be found as a stand-alone supplement, however it can also be found in combination supplements along with Aged Garlic Extract and L-theanine, which are targeted to improving blood pressure.” One such supplement: Kyolic Formula 109 Blood Pressure Health.

Also noting the role in decreasing the risk of forming blood clots, Soft Gel offers nattokinase softgels. And Daiwa produces Plasmanex1, which contains Bacillopeptidase F isolated from natto and has been shown in scientific research to support healthy blood circulation and to prevent the blood clots that can lead to stroke, heart attacks and other myocardial damage.

Probiotics The heart health category has a new entrant, says Kaneka’s Shastri: probiotics. “A few years ago, our company began a deep-dive into the cardiovascular application of probiotics. Today, we have a potent probiotic formulation called Floradapt Cardio to help people improve their lipid profiles.” He explains that this is a patented formulation of 3 different Lactobacillus plantarum strains. “We conducted an extensive search of strains with the strongest BSH (Bile Salt Hydrolase) enzyme activity. Strains with the most potent BSH activity counter bile-salt integrity in the gut. Bile Salts are made from cholesterol, and thus bile salt hydrolase forces the liver to utilize more endogenous cholesterol to produce more bile salts.” He adds that Kaneka’s published work has shown double-digit reductions in LDL, as well as reductions in oxidized LDL.

Caring for Young Hearts

By Trisha Sugarek MacDonald, BS, MS, Sr. Director of Research & Development, Bluebonnet Nutrition Corporation

Don’t forget about your younger customers. America’s youth is increasingly becoming overweight. In fact, approximately 18.5% of America’s youth is affected, which is about 13.7 million children and adolescents. Obesity prevalence was 13.9% among 2- to 5-year-olds, 18.4% among 6- to 11-year-olds, and 20.6% among 12- to 19-year-olds, according to the CDC. It is fundamental before suggesting heart health products to advocate a healthy lifestyle. Health food stores can provide their clientele with literature, or maybe host kid-friendly educational seminars for parents and their children. Several key factors given to us by The American Heart Association that should be implemented into these educational tools include:

  1. Being a positive role model. When the parents practice healthy habits, it is easier to convince their children to do the same. Parents must lead by example.

  2. Incorporating a higher level of physical activity via family outings, such as walks, swimming, biking, hikes, and more. Physical activities that children really enjoy, like swimming, hopscotch, tag and jungle gyms, should be included.

  3. Limiting TV, video game and computer timehabits that influence a sedentary lifestyle and provide time for snacking.

  4. Being supportive, focusing on the good and promoting a positive self-image.

  5. Setting specific goals and limits, such as time frames for physical activity (1/2 to 1 hour of playtime), sweets (maybe 1 cookie a day instead of a box) and then reinforcing good behavior.

  6. Not rewarding with food. Find other ways to celebrate good behavior in children, such as a trip to the park, a new book, or an article of clothing they have desired.

  7. Setting aside a specific time for dinner for the entire family. This will aid in decreasing the consumption of caloric-dense foods and/or reduce snacking. Plus, getting the kids involved in cooking and meal planning will not only provide time for building a stronger family unit, but also allow everyone to develop better eating habits.

  8. Making a game of reading food labels. This will not only enhance the knowledge of what you and your family are putting into your bodies, but will also allow you to make healthier choices. Label reading is a tool that can be utilized for a lifetime.

  9. Being an advocate for healthier children. Insist on good food choices at school, like water, fruits, vegetables and whole-grains versus French fries, burgers or chips. Plus, consult with your children’s healthcare provider and start monitoring cardiovascular indicators like BMI, blood pressure and cholesterol. Contact public officials on matters of the heart.

More of nature’s gems There’s a wealth of options here—our experts walk us through some of the research-backed gems from nature.

Lycopene: “A growing body of research demonstrates the huge potential of carotenoids such as lycopene,” says Raz: They have anti-oxidative and anti-inflammatory qualities which, studies suggest, can improve cardiovascular wellness (5). Lycored has commissioned several studies contributing to the body of evidence for the role of natural carotenoids in cardiovascular wellness. Most recently, a double-blind randomized study showed that tomato phytonutrients have a beneficial effect in maintaining blood pressure within normal range, but synthetic lycopene alone does not (6). Cardiomato—Lycored’s proprietary mix of carotenoid-rich tomato extract and phytosterols—has also been shown to help reduce levels of LDL cholesterol (7).

Also speaking to the benefits of lycopene, Holtby says, “Lycopene has been the subject of a number of epidemiological studies that indicate there is an inverse relationship between blood lycopene levels and cancer risk. Another study published in the journal Nutrition, Metabolism and Cardiovascular Disease has demonstrated that not only is lycopene a potent antioxidant, but that a synergistic mix of tomato phytonutrients in a similar ratio to that found in nature renders LDL-C 90% more resistant to oxidation than LDL-C alone. Moreover, research conducted at the Soroka University Medical Center in Ben Gurion, Israel, found that a whole-tomato extract has a beneficial effect on blood lipids, lipoproteins, oxidative stress markers, in addition to lowering blood pressure at levels comparable to conventional treatment. We offer softgels containing standardized extracts of lycopene, a carotenoid offering superior antioxidant activity. In addition to quenching free radicals, studies have demonstrated that supplementation with lycopene may be associated with a reduction in systolic and diastolic blood pressure.”

Garlic Extract: This is Wakunaga’s specialty—the company manufactures a range of heart-specific supplements based on Kyolic Aged Garlic Extract (AGE), and has over 840 peer-reviewed articles on the efficacy of its use for cardiovascular and other health benefits, according to Levy. “AGE works on multiple cardiovascular risk factors—both alone or when combined with other nutrients,” he adds. “Research shows that AGE inhibits the production of prostaglandins (hormone-like substances involved in inflammation) and lowers homocysteine, which is a risk factor that damages endothelial cells and induces blood clots (thrombosis) that can trigger a heart attack or stroke.” And the list of benefits goes on—head to for a look at the science.

Plant Sterols: An ingredient gaining traction among those looking to improve their cholesterol levels: “Plant sterols—technically known as phytosterols—are naturally-occurring compounds found in many vegetables and legumes,” says Levy. “When taken in supplemental form, they can have a significant impact on cholesterol levels. Because they have a chemical structure similar to cholesterol, plant sterols can block cholesterol absorption in the intestine by as much as 10% and help lower triglycerides.” He adds that plant sterols in clinically significant dosage, along with AGE, can be found in Kyolic Formula 107 Phytosterols.

Also offering plant sterols: NOW Beta-Sitosterol Plant Sterols features CardioAid-S Plant Sterol Esters, a combination of the ester forms of Beta-Sitosterol, Campesterol, and Stigmasterol, says Levin. “Foods containing at least 0.65 grams per serving of plant sterol esters, eaten twice a day with meals for a daily total intake of at least 1.3 grams, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease (FDA Qualified Health Claim). A serving of NOW Beta-Sitosterol Plant Sterols with Fish Oil supplies 1 gram (1,000 mg) of plant sterol esters in a base of fish oil.”

Olive extract: “Olive oil polyphenols such as oleuropein and hydroxytyrosol have been studied extensively for their antioxidant and anti-inflammatory effects,” says Laetitia Petrussa, Product Manager at IFF Health. “It has been established that hydroxytyrosol-rich olive oil decreases the oxidation of LDL cholesterol, an important atherogenic factor. Consequently, the European Food Safety Authority (EFSA) approved a health claim that ‘olive oil polyphenols contribute to the protection of blood lipids from oxidative stress.’ Experimental studies on oleuropein have further revealed anti-thrombotic, anti-atherogenic and vasodilatory properties.” Petrussa says Benolea is extracted from the leaves of the olive tree with standardized polyphenolic compounds that may support cardiovascular health via two mechanisms: “First, it promotes the production of nitric oxide (NO), an important mediator of vasodilation. NO helps relax the smooth muscles surrounding blood vessels, decreasing blood pressure. Second, the phenolic substances found in olive leaves seem to inhibit angiotensin converting enzyme (ACE), decreasing the formation of angiotensin II. This can lead to a systematic dilation of arteries and veins further decreasing arterial blood pressure.”

Grape Seed Extract: “Three of our best-selling heart health supplements are Clinical OPC, Clinical OPC Extra Strength, and Clinical OPC Heart,” says Myers. “Each one features our French Grape Seed VX1 extract. It may sound strange to talk about grape seed extract when there have been products on the market for so long, but the tannin-free extract in our products helps the valuable compounds in grape seed actually live up to their potential. And there is a lot of potential there. That’s because grape seed extracts can address so many of the concerns that lead to heart disease: reducing high blood pressure, protecting the blood vessel walls from free radical damage, and preventing the dangerous oxidation of LDL cholesterol.”

Myers points to an Italian clinical study in which individuals with pre- or mild hypertension were divided into three groups, two with grape seed extract, at lower (150 mg daily) and higher (300 mg) dosages, and one with a diet and exercise intervention only, serving as a control group. “At the end of the four-month trial, both grape seed extract groups saw an improvement in blood pressure, although those at the higher dosage noticed more dramatic effects. In fact, blood pressure numbers normalized in 93% of those in the higher dosage group.”

Other scientific studies have also shown benefits: grape seed extract helps prevent blood clots from forming without thinning the blood, lowers blood pressure, and shields blood vessels and arteries from free radical damage. And, Myers adds, “A Yale review of grape seed extract studies concluded from the existing research that this powerful botanical lowers systolic blood pressure and heart rate, so a broad spectrum of medical experts have definitely taken notice.”

Levin adds that NOW offers Blood Pressure Health with MegaNatural-BP Grape Seed Extract flavonoids, which studies suggest that can help maintain blood pressure already within the healthy range. “In addition, NOW has included standardized Hawthorn Extract to complement this patented grape seed extract. Hawthorn Extract has powerful flavonoids, including standardized Vitexin that, along with other components in Hawthorn, have also been found to provide free radical protection and promote normal cardiovascular function.”

Aronia: “A newer player in the heart health category in the U.S. market is Aronia berry,” says Tower. “Also known as chokeberry, Aronia (Aronia melanocarpa) has emerged onto the scene as one of the most promising new heart health ingredients with substantial scientific support behind it. Though well-known for decades in European markets, it is more recent that the U.S. has embraced the body of Aronia berry research. Research studies have investigated the effects of Aronia on several markers of heart health, with the most notable being its effects on blood pressure and cholesterol. A recent study has shown Aronia berry polyphenol consumption reduces plasma total and low-density lipoprotein cholesterol in former smokers without lowering biomarkers of inflammation and oxidative stress (8).”

Tower adds, “Typically, the most at-risk group for heart disease are adults ages 50 and up, and Aronia supplementation was shown to particularly influence this group (meta-analysis publication pending), although Aronia berry has appeal and benefits for people of all ages.”

Assorted Herbs & More: “The major cause for cardiovascular illness is insulin resistance. This manifests as metabolic syndrome, which is a combination of high blood pressure, high cholesterol, and prediabetes or diabetes,” says Jacob Teitelbaum M.D., physician and researcher, as well as author of Diabetes Is Optional. “My favorite supplements to address metabolic syndrome include: the herb Hintonia Latiflora (available as Sucontral D). This has been studied in about 10 published studies for addressing diabetes and insulin resistance. It has been shown to decrease glycosylated hemoglobin about 1% after six months. This is rather dramatic and on par with diabetes medications.” He also notes that both low magnesium and low vitamin D have been associated with metabolic syndrome. “I recommend a multivitamin that has 150 – 200 mg of magnesium and 400 – 1000 units of vitamin D.”

Also discussing the power of herbs: “Pterostilbene, the active ingredient of Sabinsa’s Silbinol range of products, is a well-known antioxidant supplement for cardiovascular health made from the heartwood of Pterocarpus marsupium, also known as the Indian Kino Tree,” says Dr. N. Kalyanam, President R&D for Sami-Sabinsa Group. “A study was collaboratively published last year by Sabinsa researchers and academic scientists from Taiwan and China on the prevention of atherosclerosis promoted by toxins such as Trimethylamine-N-Oxide and the ability of Silbinol to promote beneficial microbiota in this context (9). Sabinsa scientists also published on ameliorating effects of Pterostilbene on cardiac hypertrophy and hypertension (10).”

Two additional antioxidant ingredients known for cardiovascular support that Sabinsa offers include: Resvenox, a natural 95% resveratrol from Polygonum cuspidatum, or knotweed, and Sabeet, a standardized extract from Beta vulgaris, also known as beetroot, says Dr. Kalyanam. And for cholesterol management, Dr. Kalyanam points to Gugulipid, a product made from guggul (Commiphora mukul). Fiber-rich products such as Fenufiber from fenugreek seed, he adds, also have demonstrated applications for heart health benefits.

On the manufacturer side, Shaheen Majeed, President Worldwide of Sabinsa (owner of and manufacturer for America’s Finest, Inc. and Sanutra), adds that two ingredient-specific formulas can be found with the AFI label, and a comprehensive cardio and cholesterol support formula in its Sanutra line: AFI Silbinol offers 450 mg of Indian Kino Tree (Pterocarpus marsupium) extract, providing 22.5 mg of Pterostilbene per vegetarian capsule. Majeed says pterostilbene is an antioxidant compound, chemically similar to resveratrol, but more bioavailable and efficacious, and is also recognized for reducing LDL cholesterol in numerous clinical studies. AFI Gugulipid Plus LactoSpore offers 1,000 mg of Gugulipid Guggul (Commiphora mukul) Gum Resin Extract providing 25 mg of Guggulsterones, plus 100 million CFUs of LactoSpore Bacillus coagulans probiotic per caplet. He adds that Guggul, a tree native to India, has a long history of use in Ayurveda for a variety of ailments. “PubMed cites over 450 publications on the plant alone, and over 200 on its major compound, guggulsterone. Multiple clinical studies in India report of its cholesterol-reducing effects, and a publication in the journal Science reported its mechanism of action as guggulsterone targets and blocks the activity of the Farnesoid X Receptor (FXR). FXR is involved in regulation of cholesterol by monitoring levels of bile acids, which are produced from cholesterol and released by the liver.” And finally the Sanutra Cardio & Cholesterol Support Formula provides: 400 mg Slow Release Niacin; 300 mg of Gugulipid Guggula (Commiphora mukul) Gum Resin Extract providing 15 mg of Guggulsterones; 100 mg Arjuna (Terminalia arjuna) Bark Extract providing .5 mg of Arjunolic Acid; 20 mg of Sugarcane (Saccharum officinarum) Wax (Policosanol) providing 12 mg of Octacosanol; and 5 mg BioPerine Black Pepper (Piper nigrum) Fruit Extract providing 4.75 mg Piperine in a sustained-release, bi-layer technology caplet. “Niacin, Gugulipid, Arjuna, and Policosanol support heart function and help maintain cholesterol levels that are already within normal range. BioPerine improves the absorption of the four active compounds.”

Black seed oil also deliver heart-healthy benefits. Judy Gray, Founder/President of North American Herb & Spice, notes that it has been used throughout the centuries as body support to resist stressors of all kinds, as well as supporting heart health. The company offers an extended line in the black seed oil category including Cardio Plus and Absorb-Max TQ.

Warding Off Inflammation

By Steve Holtby, President & CEO, Soft Gel Technologies, Inc.

Over the past 30 years or so, Americans have replaced much of their dietary saturated fat with omega-6 fatty acids. It is estimated that people are now eating 20 times more omega-6s than omega-3s. From a biochemical standpoint, this lopsided imbalance in dietary intake of the omega-6 and omega-3 fatty acids sets the stage for powerful and chronic pro-inflammatory reactions. As humans grow older, systemic inflammation can inflict devastating degenerative effects throughout the body.

The simplest and most biochemically sound way of turning down the body's pro-inflammatory prostaglandins and cytokines is by restoring a balance between pro- and anti-inflammatory foods. From a dietary standpoint, this means switching from vegetable oils to extra-virgin olive oil (high in anti-inflammatory omega-9 fatty acids). It also means avoiding most processed (boxed, canned, or frozen) foods, because their makers frequently add omega-6 fatty acids. By eating simple unprocessed foods—such as baked chicken, a salad, and steamed vegetables—it becomes easier to consume a more balanced ratio of omega-6 and omega-3 fatty acids.

However, most people have been eating a diet high in omega-6 fatty acids and low in antioxidants for years. Simply restoring a balance is not enough to quickly offset accumulated damage, because the fatty acid composition of the body’s cells reflects their dietary ratios. It’s imperative to increase consumption of anti-inflammatory fatty acids and antioxidants.

Antioxidant-rich foods and/or supplements provide powerful compounds that not only slow oxidation, but also serve as anti-inflammatory agents. Bioflavonoids like quercetin, resveratrol, and polyphenols have natural anti-inflammatory properties. A diet that includes coldwater fish such as salmon and tuna, plus abundant vegetables and fruits and limits the amount of saturated fats and trans fats, would be helpful in combating inflammation. A Mediterranean diet, exercise, marine lipids (a source of essential fatty acids), CoQ10 and other dietary supplements can impact oxidative stress and inflammation.

Although dietary supplements can have a meaningful impact on maintaining healthy heart function and preventing cardiovascular disease (CVD), it is important not to forget that simple lifestyle factors—such as daily movement or exercise, sound dietary choices that include fresh fruits and vegetables, drinking at least eight 8-oz glasses of water every day, managing stress through meditation or focused breathing, getting enough sleep, and avoiding smoking—are some of the most powerful tools available for optimizing heart health.

What's next for heart health We can expect to continue to see an awareness of the lifestyle and nutrient factors that make for a healthy heart, but coupled with more trust in the right kinds of natural products that provide valuable assistance without the risks of conventional drugs, says Myers. “There’s no reason to start children on statin drugs, for instance–not when we know that there are natural solutions that work as effectively for cholesterol and have only positive systemic effects.”

As people become more aware of the dangers of statins, Myers adds, watch for amla (also popularly known as Indian gooseberry and officially known as both Emblica officinalis and Phyllanthus emblica) to gain more attention. “Amla is a superstar waiting to explode on the natural products stage,” she predicts. “Amla can do what statins are supposed to do without risk. For example, a clinical study showed that participants taking amla increased high-density lipoprotein (HDL) by 14% and decreased low-density lipoprotein (LDL) cholesterol by 21%. Their total serum cholesterol was reduced by 17% and triglyceride levels dropped by 24% within three months.” Europharma offers Healthy Cholesterol with Amla, featuring a clinically studied amla.

Also pointing to the power of amla, Bruce Brown, MPH, MA, President, Natreon, says: “In traditional Ayurveda, amla as an adaptogen supports the body’s natural balance by offering a cooling effect primarily in support of healthy digestion and circulation. Natreon’s clinically studied Capros Amla is standardized to polyphenols proven to provide cardio-protective benefits by enhancing blood vessel function and supporting a healthy lipid profile. Consumers use Capros as an adaptogen to aid in healthy digestion and to promote heart health.”

Interest in “calm” will also growand this can help with sales, suggests Raz. “Positioning can be a challenge in the increasingly crowded CVH space. One approach with untapped potential is to market products with messaging that appeals to a desire for calm. We asked consumers ‘How appealing do you find the idea of being able to ‘calm your heart’, in the same way you can ‘calm your mind’?’ Almost all (95%) said they found the concept either very appealing or somewhat appealing, and the figure was even higher in the US (99%). Furthermore, over a third (35%) of consumers overall, and 43% of those in the U.S. said they would be more likely to buy a CVH product if its branding or packaging included the word ‘calm.’ In other words manufacturers could gain from shifting their value proposition from a negative (the avoidance of risk) to a positive (the promotion of daily calm).” WF



2) American Journal of Hypertension; Published online ahead of print, doi: 10.1093/ajh/hpu024 “Long-Chain Omega-3 Fatty Acids Eicosapentaenoic Acid and Docosahexaenoic Acid and Blood Pressure: A Meta-Analysis of Randomized Controlled Trials”

3) J Clin Lipidol. 2018 ; 12(3): 718–727.e6. doi:10.1016/j.jacl.2018.02.010.

3-b) American Journal of Cardiology 2004 Nov 15;94(10):1306-10. Effect of atorvastatin on left ventricular diastolic function and ability of coenzyme Q10 to reverse that dysfunction.

4) Knapen MHJ et al. “Menaquinone4-7 supplementation improves arterial stiffness in healthy postmenopausal women. A double-blind randomised clinical trial.” Thrombosis and Haemostasis, 2015 May;113(5):1135-44.

5) Gammone, M.A., Riccioni, G. & D'Orazio, N. 'Carotenoids: potential allies of cardiovascular health?' Food Nutr Res. (2015)

6) Wolak, T. et al. 'Effect of Tomato Nutrient Complex on Blood Pressure: A Double Blind, Randomized Dose–Response Study' Nutrients (2019)

7) Deplanque X, Muscente-Paque D, Chappuis E. ‘Proprietary tomato extract improves metabolic response to high-fat meal in healthy normal weight subjects.’ Food Nutr Res. 2016;60:3253

8) Xie, L., Vance, T., Kim, B., Lee, S. G., Caceres, C., Wang, Y., ... & Bolling, B. W. (2017) Nutrition research, 37, 67-77.

9) Koh, Yen‐Chun, et al. “Prevention of Vascular Inflammation by Pterostilbene via Trimethylamine‐N‐Oxide Reduction and Mechanism of Microbiota Regulation.” Molecular Nutrition & Food Research, vol. 63, no. 20, 12 Aug. 2019, p. 1900514, 10.1002/mnfr.201900514. Accessed 27 Dec. 2019.

10) Akinwumi, Bolanle, et al. “Disparate Effects of Stilbenoid Polyphenols on Hypertrophic Cardiomyocytes In Vitro vs. in the Spontaneously Hypertensive Heart Failure Rat.” Molecules, vol. 22, no. 2, 1 Feb. 2017, p. 204,, 10.3390/molecules22020204. Accessed 27 Dec. 2019.