Beyond weight management and energy sustenance, heart health is a huge category of interest to many dietary supplement/n atural health consumers. The fear of having a heart attack haunts just about everyone age 35 and older. The category is vast and there have been key research findings that have changed the way cardiologists, nutritionists and the dietary supplement industry view and respond to preventive heart care solutions.

A Rapidly Evolving Category
Market Drivers. Momentum in the heart health category has increased in recent years thanks to several interrelated factors. First and foremost, there’s been a spike in research on and advertising of heart health products (supplements and pharmaceuticals) over the past few years. These factors, combined with increased support from physicians, have made the heart health category particularly hot. “Supplements are more widely used and now are even promoted by doctors, who in some cases offer their own supplement lines,” observes Mary Ann Siciliano, national sales manager for Arista Industries, Wilton, CT, a supplier of healthy oils. She also notes that the heart health category doesn’t stop with supplements: “Functional foods, in which added nutritional benefits are included in regular everyday products (like cereals, yogurts, sauces, salad dressings and breads) are very popular and are more advertised and readily available.”

Another cause for increased foot traffic in your heart health aisles could be recent research showing that women have reached the same statistical level of risk for heart disease as men. “This made heart disease the number-one killer of everyone in the United States,” emphasizes Autumn Blum, formulator and CEO of Organix South, Bowling Green, FL.

But perhaps the biggest market driver in this category is the increased prevalence of (and knowledge about) related health conditions such as obesity, periodontal diseases, diabetes and other conditions that impact cardiovascular function. These entwined health concerns have made consumers think more proactively about heart health.

Interrelated Heart Health Conditions and Risk Factors. There is a decidedly increased body of knowledge regarding heart risk factors and the interrelation of the conditions of metabolic syndrome, diabetes and heart disease, points out Jolie M. Root, LNC, LPN, a nutrition educator at JR Carlson Laboratories, Arlington Heights, IL. “Metabolic syndrome with its characteristic insulin resistance exhibits multiple signs that are similar to those of heart disease. Such metabolic abnormalities include hypertension, hyperinsulinemia and hypertriglyceridemia,” she notes.

Neil E. Levin, CCN, DANLA, nutrition education manager for NOW Foods, Bloomingdale, IL, also sees more research demonstrating that metabolic syndrome ties into several measures of circulatory health, including high blood pressure, elevated cholesterol/lipid markers and other factors. The testing of oxidative stress and inflammatory markers such as homocysteine as possible contributors to cardiovascular problems has continued. “However, this research often has showed conflicting results probably due to unseasoned researchers unfamiliar with nutrient interactions and pathways,” he points out. “All of these things remind us of the central importance of nutrition to cardiovascular health. There is certainly greater knowledge and awareness, but there is still a tremendous amount of confusion.”

The concept of cholesterol has changed significantly, nearly turning on its head over the past few years. Root says that more specific screenings have pointed to cholesterol particle size as being more telling of risk than simply the total of calculated levels of cholesterol. “For example, small, dense low-density lipoprotein (LDL) and low high-density lipoprotein (HDL) are now figured into the risk equation, as are the subclasses of HDL such as HDL 2 and HDL 3, and so are inflammation and hypercoagulability.

Naturally, insulin resistance is a major risk factor for the development of type 2 diabetes,” says Root, who adds, “Diabetes incidence has increased 90% in the last decade.

Underlying all of this is the national increase in obesity. Obesity plays a role both in exacerbating insulin resistance and as an independent risk factor for atherosclerosis. Heart disease is the leading cause of death among persons with diabetes, so any patient with insulin resistance has numerous reasons to be at very high risk for atherosclerosis.”

In agreement is David Winston, founder of Herbalist & Alchemist, Washington, NJ, who sees an increased interest in controlling cholesterol. However, he says, one of the problems is that people remain focused on total cholesterol numbers, which are no longer as meaningful. “It is much more important to look at the fractionated cholesterols. LDL, VLDL, HDL, VHDL and the comparisons between those are much more important than the total cholesterol number.”

Related to cholesterol is triglyceride levels, which also are an important independent factor for assessing heart health. Says Stuart Tomc, national educator at Nordic Naturals, Watsonville, CA, “Triglycerides alone increase the risk of heart attacks nearly three fold, according to a Harvard led study published in Circulation. The cutting edge research published December 2008 in FASEB Journal even suggests that inflammation alters HDL cholesterol thereby forcing the industry to further abandon the simplistic reductionist ideology of LDL ‘bad’ and HDL ‘good.’”

In fact, inflammation is an emerging risk factor of cardiovascular disease that has also recently been the impetus for numerous new and reformulated heart-health products. “Our understanding of the etiology of heart disease has really blossomed over the last few years notably with what may be the most significant insight by Libby et al. that cardiovascular disease is an inflammatory disease,” says Christopher Hobbs, L.Ac, AHG, formulator for Rainbow Light Nutritional Systems, Santa Cruz, CA. “Through chronic inflammation, vessel walls are transformed from flexible, supple and healthy tubes that are able to carry life-giving blood to all the cells and tissues of the body to hardened and clogged pipes that become increasingly limited in their function over the years,” he describes. “A simplified medical understanding of chronic cardiovascular disease is simply chronic microinflammation in the vessels, leading to sclerosis (scarring and laying down of inflexible scar tissue) and thickening of the vessel walls. This chronic low-grade inflammation is insidious because it produces few symptoms until the process is rather advanced to the point where blood circulation to vital cells, tissues, and organs becomes severely inhibited.”

There has been an increased push from the orthodox medical community to get everybody on statins, says Winston, which some research suggest exert some benefit by working primarily as anti-inflammatories, almost as vitamin D analogues. In his view, this opens up wondrous opportunities for medical science to look more closely at the roles of a variety of botanicals and other supplements that address inflammation.

“We know many herbal products are phenomenally effective anti-inflammatories. It would be very interesting to do some studies to find out if very powerful anti-inflammatory herbs such as hawthorn, turmeric, blueberry, green tea and ginger, along with vitamin D (deficient in many Americans), might turn out to have as much benefit for lowering cholesterol and act as a cardiovascular disease preventative without the side effects of statins,” Winston notes. It should be noted that, according to the Physician’s Desk Reference, 0.5%–2.3% of statin users experience side effects, which equates to more than half-a-million people. Such side effects may include muscle pain, weakness, migraines, tingling and more. Some research has indicated that statin use may deplete coenzyme Q10 (CoQ10) levels, a powerful that is key for heart health.

A theoretical practice in traditional Chinese medicine, called Yin deficiency, may also lend tremendous import in addressing inflammation, Hobbs points out. Yin deficiency is brought about by uncontrolled stress, and overindulgence in red meat, alcohol and processed foods loaded with simple sugars; these are factors known to promote chronic inflammation. Hobbs believes in combining Chinese and Western medicines to provide a more holistic protocol in slowing the processes of inflammation and thereby reducing risk of cardiovascular disease.

Category Management:Unclogging Shelves
The profusion of products that vie for limited shelf space necessitates a constant monitoring of what you are offering to your specific community. It also requires continued education for retailers and their staff to keep apprised of the newest research and what manufacturers are offering along with the reams of support literature and education they proffer to assist retailers in dispensing updated information. Consider renovating your heart health department to make it informative, attractive and interactive to engage consumers and help them make the most suitable choices.

Education. Sources for this feature urge retailers to take full advantage of the abundant well-written literature provided by manufacturers, plus the latest books exploring natural and healthy ways to achieve cardiovascular wellness. Far beyond any other type of retailer that also sells a smattering of heart-healthy supplements, the specialty supplement retailer has the singular advantage of success by providing in-depth product education and personalized attention/consultation.

Heart Health, states Marci Clow, MS, RD, Rainbow Light’s senior director of product research, must have a prominent and in-depth literature kiosk that is continuously updated. She suggests providing current heart health articles and research study results in an attractive literature display, along with any company literature and product coupons for your selection of heart health products. If budget and technology allows, set up a viewing station with heart health-specific podcasts from health experts to immediately grab consumers’ attention and generate interest and motivation to purchase.

Tomc stresses contacting manufacturers to bring in their spokespeople for both in-store seminars and local radio shows. Also, producing a newsletter, creating targeted mail lists and having active demonstrations work to bring in a steady stream of new customers.

Selecting and Grouping Products. Levin, who has over 30 years of natural products retail management experience, suggests that retailers categorize their heart health department into subsections such as blood pressure, circulation, lipid balance, and energy (CoQ10, carnitine), which helps consumers zero in on the direct support they need, as told to them by their doctors.

Avoiding hefty product redundancy is important, so as to give space to things that may be cutting-edge. Trisha Sugarek, research and development, technical support at Bluebonnet Nutrition, Sugar Land, TX, suggests rotating three top heart-health supplement choices for premiere spotlight every month. For example, one month create an endcap with red yeast rice, ubiquinol and omega-3 fish oils, with corresponding literature. Change these three the next month and so on. Clow recommends avoiding a proliferation of single-ingredient products that require your customers to piece together a complicated program or to have researched the category extensively.

Redundancy is not a huge problem in a category like heart health, as it is a concern for such a large portion of the market, Blum of Organix South believes. She recommends reviewing the category twice a year to see what is moving, what is in the news and which companies support you with education. These three criteria will help you to decide how to alter the mix. In tandem, look more closely for redundancy in categories that do not make up a large part of the market, such as kidney stone support, which is important but small compared to heart support. In smaller categories/concerns, narrow the product mix to one or two brands that work well.

The next step is to select the most appropriate heart health supplement mix that will enjoy high continual velocity. “Consider doing a product inventory overhaul,” says Andreas Koch marketing director of Barlean’s Organic Oils, Ferndale, WA. “First, run a report and determine which SKUs are the best sellers then yank the slow-turning dogs by selling them at a special discounted promo. This SKU reduction creates a cleaner, more efficient working category. The remaining few all-star SKUs will also improve customers’ shopping experience since the confusing clutter is gone. Fewer SKUs with deeper inventory means less out-of-stock loss sales, too.”

Blum recommends that retailers consider various price points (higher end, mid-range and less-expensive products), opening wide the selection process and increasing sales opportunities. “I always suggest a brand mix that capitalizes on the best sellers in the category but leaves room for the newest and hottest products,” she notes.

“Consumers are looking to simplify their lives, and this includes their supplement regimens,” says Clow. “Offer all-in-one products that multitask such as a multivitamin with high potencies of heart healthy antioxidants and key B vitamins, or an omega product with both fish and flax for comprehensive support.”

According to Eileen Sheets, managing director of Bioforce USA, the most important thing for a retailer to do is to establish relationships with several top-notch manufacturers. They should make these their partners and use what the manufacturers offer in the way of training, product information and point-of-purchase materials. It is important that all the employees in the aisle have a good working knowledge of the products in the store. Don’t hesitate to ask your manufacturers for samples for your staff to try, Sheets says. “If the retailer can develop an array of products they have used and can stand behind, their confidence in those products really communicates to the customers,” she suggests.

Marketing and Placement. As with any other category, your heart health section can’t just be left to function autonomously if you want it to be successful and a magnet for consumers. Cross-promotion can do wonders and boost sales of foods, beverages and other products. A great start is the multivitamin, say both Clow and Levin. Any staffer can approach someone in the heart care department to inquire how satisfied he or she is with the multivitamin he/she is taking. (Remember, make this open-ended, not “do you take a multi?” which often leads to the closed “yes” response, making it difficult to achieve an add-on sale.) Clow suggests that you provide coupons as well, such as a discount on a heart-healthy multivitamin with purchase of an omega-3 supplement.

And because diet has a huge impact on cardiovascular status, several sources suggest placing bold signage in both the health care aisle and specific foods. Sugarek’s suggestion is to cross merchandise three heart-smart supplements (e.g., red yeast rice, ubiquinol, fish oil) with 70% cocoa chocolate bars or blocks of chocolate. Koch and Winston suggest creating a demonstration table with supplements and foods that are heart healthy such as oatmeal and dark chocolate.

Malone agrees, asserting, “Instead of just putting heart supplements up on an endcap, showcase them right along with healthy foods, foods high in fiber, books on better diet, exercise and lifestyle. Have some handouts available on some good cardiovascular exercises so people can take these materials home and really start working on the life changes that’ll help their hearts. The answer doesn’t just come in a bottle. A good heart health department in a store has to include foods, books, and good, sensible reminders.”

Further, he recommends promoting heart products during National Blood Pressure Awareness Week and National Quit Smoking Week, for example. “All the manufacturers run their heart ads on Valentine’s Day, but heart health should be treated as a year-round objective, not just a seasonal special event. When your heart is under stress, it’s under stress every day, not just on February 14th!”

Blum ventures a creative concept that is fun and engages customers: she suggests first poring through manufacturer literature to come up with a series of about five questions for a rewards program, “Heart Health Hunt.” Print up the Q&A cards and place a product name as the answer; the customer has to find the item and read the answer to the question placed there. “Customers who complete the hunt will have learned new facts about heart health and retailers can reward them with a discount.”

As a specialty retailer, your community expects you’ll provide them with the most cutting-edge and sophisticated products, a deep product selection, superior quality products, and of course, the personalized service and self-education tools. Once you are satisfied with the vigor of your heart-care and other departments, then a more aggressive outreach via PR, advertising and promotion will significantly increase your customer loyalty and sales. After all, you are the heart of your community when it comes to purveying products and practices for a healthy lifestyle! WF

Published in WholeFoods Magazine, February 200