Cardio Care for the Conscious Consumer

A holistic approach to heart disease is the right way to save lives

References

Stats don’t lie, but they don’t exactly tell the whole story either. The numbers say cardiovascular disease (CVD) is the top killer of Americans; it is the direct cause of 500,000 deaths in the United States each year and kills 7 million worldwide. But the numbers don’t come right out and say heart disease starts long before most people think about heart health and cholesterol. Most of all, the numbers, facts and figures fall short of demonstrating just how many lives can be improved and saved through intervention with natural products.

The first cardiovascular trouble involves blood contents, specifically lipids such as cholesterol and triglycerides. Triglycerides are the form in which fat exists in the body and, like cholesterol, they can be ingested or synthesized in the body and stored for use as energy between meals. Elevated triglycerides (hypertriglyceridemia) can contribute to atherosclerosis, plaques from hardening arteries; but, the situation with cholesterol is not as simple.

Low-density lipoprotein (LDL) transports cholesterol and triglycerides to the arteries, where they can be released, possibly oxidized and contribute heavily to formation of plaque (atheroma). On the other hand, high-density lipoprotein (HDL) carries cholesterol away from atheromas and to the liver for removal. Thus, LDL is considered “bad,” and HDL deemed “good.” Adding another level to cholesterol and heart health, researchers are increasingly learning the progression of atherosclerosis is more dependent on the size and concentration of LDL, with small amounts of large particles better than lots of small particles. Apolipoprotein B (ApoB), a structural protein, is a marker of small LDL; screening for apoB might provide a better indication of LDL particle size, and thus atherosclerosis risk.¹ Through the years, a number of natural products have been researched and touted for managing LDL and HDL levels, as well as controlling triglycerides and delivering good ApoB scores.

One of the original dietary heart health staples, fiber, has two different forms—one of which can help lower LDL cholesterol.

Beta-glucan fiber from oats may lower cholesterol as well as speed intestinal contents.² A University of Minnesota trial showed animals administered oat beta-glucans (as Oat Vantage™, from Nurture Inc.) experienced increased viscosity of intestinal contents and a reduction in liver cholesterol concentration.³ Other trials found similar reductions specifically in LDL cholesterol, with pronounced benefit to those with dangerous cholesterol levels (more than 200 mg/L).^4,5Barley fiber possesses similar potential in blood lipid management. A pair of studies on beta-glucans (as BarlÍv™, from Cargill) reported decreases in LDL concentration, particle size and number in hypercholesterolemic adults.^6,7

Sterols found in most plants—notably grains, seeds and legumes—are structurally similar to cholesterol and, thus, can compete with cholesterol for absorption in the intestines. The research on plant sterols lowering LDL and other non-HDL cholesterol is becoming robust.⁸ An Australian team concluded plant sterols (as VegaPure®, from Cognis Nutrition & Health) incorporated into butter, margarine and low-fat foods lowers LDL cholesterol, effectively countering LDL increases from butter fat.⁹ Their follow-up work revealed the benefit to LDL levels varies depending on the type of food matrix utilized, with cereal having greater benefits than milk.¹⁰ An Iowa State University study confirmed plant sterols (as VegaPure) lower total cholesterol (TC) and LDL.¹¹ University of California, Davis, scientists also concurred the LDLlowering ability of plant sterols added to foods, reporting 2 g/d plant sterols (as CoroWise®, from Cargill) added to juice reduced TC, LDL, non-HDL and ApoB in mildly hypercholesterolemic subjects.¹² Their subsequent trial confirmed LDL reduction by CoroWise, adding the juice with sterols also decreased C-reactive protein (CRP), a marker of inflammation, and raised HDL cholesterol.¹³

Despite the long-standing focus on lowering LDL and triglycerides, research has shifted recently to increasing HDL levels, according to Decker Weiss, an integrative cardiologist in private practice at the renowned Arizona Heart Hospital. “Raising HDL is actually more protective than lowering LDL,” he said. “Drug companies have been trying to pinpoint compounds for raising HDL, but recent study has failed, with 1,800 subjects dying within around three months.”

Old school cholesterol management starred the B vitamin niacin, which was used as far back as the 1950s for treating dyslipidemia. A review from the Thomas Jefferson University Heart Institute, Philadelphia, explained niacin (nicotinic acid) favorably adjusts levels of HDL and its main marker ApoA; and, while the vitamin slightly modulates LDL levels, it more importantly shifts the size of LDL particles from small to the less atherogenic large form.¹⁴ This key vascular vitamin has tested well in combination with traditional statin thereapy.¹⁵ A study published in Atherosclerosis in early 2007 found decreases in LDL concentration of 50 percent or more using extended-release niacin combined with various statins; triglycerides also decreased, while HDL levels increased.¹⁶ Extended-release niacin moderates the flushing (redness from dilated capillaries) common in higher dose or long-term niacin use.

High levels of serum cholesterol are not certain to erupt into advanced heart disease. Oxidized LDL in plaque attracts macrophages, which consume the LDL, creating large foam cells. These foam cells can rupture and create clots that can clog arteries, a process known as thrombosis. “If cholesterol is not oxidized, there will be no heart attack,” Weiss quipped. This is why his first line of defense in atherosclerosis patients is an antioxidant regimen, including vitamins C and E and alpha-lipoic acid (ALA). “This regimen significantly decreased the risk of having a heart attack,” Weiss claimed.

Vitamin E tocotrienols not only reduce TC and LDL, they also protect against LDL oxidation.¹⁷ According to a University of California, Berkeley, review, research has narrowed down this beneficial action to tocotrienols’ effect on various enzymes, namely HMG-CoA reductase.¹⁸ Studies on vitamin E tocopherols have been just as favorable. Numerous trials found tocopherol supplementation increased plasma vitamin E levels and protected LDL from oxidation, but had little effect on actual plaque size.^19,20

Vitamin E has worked well with other antioxidants. Slovakian scientists discovered a combination of vitamin E, vitamin C, selenium and beta-carotene increased antioxidant capacity in CVD patients, leading to reduced lipid peroxidation.²¹ And vitamin E formulated with astaxanthin (as AstaREAL®, from Fuji Health Science) improved plaque stability by decreasing macrophage infiltration and apoptosis in atherosclerotic rabbits.²² On its own, astaxanthin has inhibited LDL oxidation in both cell cultures and human subjects;²³ it has also shown promise in controlling hypertension and improving blood flow.^24,25 Astaxanthin and beta-carotene are among a group of plant carotenoids studied for antioxidant benefits to the cardiovascular system.²⁶

Scientists report tomato juice increases lycopene concentrations in HDL and LDL cholesterol, providing protection against lipid peroxidation.²⁷ The tomatoborne compound lycopene can protect against LDL oxidation²⁸ in addition to potential benefits to LDL degradation and particle size, as well as improved endothelial health.²⁹ The latest research results presented at the 2006 American Society of Hypertension’s 20th Annual Scientific Meeting and Exposition, San Francisco, showed increased lycopene intake (as Lyc-O-Mato™, from LycoRed) summarily increases serum levels of the carotenoid, contributing to reduced systolic and diastolic blood pressure in subjects who had previously found no benefit from conventional hypertension drugs. In results published in early 2006, the study authors reported lycopene also reduced thiobarbituric acid, a marker of lipid oxidation.³⁰

Plants contain other antioxidant substances for heart health, including flavonoids. Grape seed extract (GSE) relies on flavonoids—such as flavans, anthocyanins, quercetin, myricetin, kaempferol and resveratrol—for its antioxidant protection of arterial lipids.³¹ A bunch of studies have charted GSE’s ability to lower LDL levels and curb LDL oxidation.^32,33,34 These benefits have translated to a popular grape beverage, red wine, which can increase antioxidant activity, reduce endothelial cell adhesion, and target LDL oxidation.^35,36 Red wine and its phenols—including hydroxytyrosol, oleuropein and resveratrol—can also reduce plasma oxidative stress following a fatty meal, as well as inhibit lipid deposits in the aorta.^37,38 It might also raise HDL.³⁹

Another antioxidant guardian of cardiovascular well-being is the mitochondrial coenzyme alpha-lipoic acid (ALA). Among its list of antioxidant actions in heart health, ALA scavenges free radicals such as reactive oxygen species (ROS), and interacts with other oxidized antioxidants—such as vitamin C, glutathione and coenzyme Q10 (CoQ10)—in an effort to regenerate oxidized vitamin E.⁴⁰ By this joint antioxidant effort, ALA helps curtail lipid peroxidation and improve endothelial function, which can help control blood pressure and lipid metabolism. Other scientific work has noted ALA can improve endotheliumrelated blood vessel relaxation in diabetic subjects and mitigate hypertension resulting from hyperglycemia and high salt intake.^41,42 A McGill University research review supported these conclusions, noting the literature shows ALA can protect against both hypertension and lipid peroxidation.⁴³

Fellow mitochondrial booster CoQ10 is oft suggested by cardiologists, including Weiss, for a range of benefits to CVD. Based on research from India, administration of CoQ10 (Q-Gel®, from Tishcon) is considered useful in halting oxidative damage and atherosclerosis development in cases of elevated trans fat intake.⁴⁴ The vitamin-like compound has also demonstrated positive effects on hypertension, lowering both systolic and diastolic blood pressure in some research.^45,46 Further supporting its favor with cardiologists, CoQ10 might also be a useful adjunct to statin drugs, which may decrease CoQ10 levels in the body, especially in CVD patients.⁴⁷ Moreover, CoQ10 works well with vitamin E, raising levels of the vitamin, as well as beneficial HDL.⁴⁸

The Inflammation Equation

Plaque alone does not a heart attack make. Add inflammation, and the result is severely increased risk of heart attack, or myocardial infarction (MI)—the blockage of oxygen-rich blood to the heart muscle.⁴⁹

“With this new understanding, science can address heart disease from a more basal approach,” said Sandra Bass, Nature’s Pearl. “That is, if [scientists] can address the inflammation as a trigger, they can likely prevent the heart attack and, possibly over time, affect the severity and frequency of heart disease within humans.”

“Inflammation is where the research is and where it is going to stay,” Weiss said. He further advised inflammation in other parts of the body can adversely affect heart disease, such as with diabetes, another inflammatory disease. “Seldom do you find heart disease on its own,” he said. “Inflammation can take a slight condition and escalate it into a larger disease.”

Bass noted acute inflammation is generally treated with traditional medicines, but many consumers are realizing the importance of preventive and complementary remedies that don’t have the often devastating side effects of synthetic drugs. She cited a University of Georgia study, in which muscadine grape extract showed anti-inflammatory benefits to paw edema in animal subjects, whereas anti-inflammatory drugs resulted in higher death rates.⁵⁰

One of the most recommended natural anti-inflammatory supplements is essential fatty acids (EFAs). The heart health EFA catch of the day remains fish oil and its long-chain omega-3s EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). Fish oil has routinely compared favorably to other EFA sources in lowering LDL and triglycerides.^51,52,53 In fact, fish oil supplementation increases DHA levels in triglycerides and other lipids, which can help quell arterial dysfunction and lesion development.⁵⁴ Numerous trials and reviews point to fish oil’s control of various inflammatory compounds that can affect vascular integrity and atherosclerosis progression.^55,56,57 Marinesource EFAs have proven potentially protective against arrhythmia,^58,59 irregular heartbeats that can cause dangerous or fatal ill-timed contractions of the heart. A 2006 British review pointed to mounting evidence of the role of inflammation in arrhythmia, suggesting fish oil intervention might help prevent atrial fibrillation, a form of arrhythmia.⁶⁰ Overall, intake of fish oil and other EFAs has been linked to decreased risk of heart attack, stroke, cardiac arrest and CVD mortality—especially sudden cardiac death.^61,62,63

“According to a recently conducted survey on health and wellness trends, 69 percent of U.S. consumers associate at least one major health benefit with both fish and omega-3s—of which heart health is the most commonly identified,” said Kristen Trautman, product category coordinator for Bioriginal.

Atherosclerosis, with its cholesterol-laden plaques and inflammation triggers, can certainly advance CVD to dangerous stages, including heart attack and stroke. However, one of the greatest threats to heart health is hypertension—chronic elevated blood pressure. Although the causes of most cases of hypertension are not definitive, the condition can stem from a number of causes including hardened arteries, excessive salt intake, stress and conventional medicines (steroids and non-steroidal anti-inflammatory drugs [NSAIDs]). Hypertension forces the heart to work harder, potentially causing the heart muscle to thicken and enlarge. A chronically enlarged heart is destined to fail. The increased pressure on the arterial walls can also cause the wall and any plaques to weaken and break, ripening the scene for dangerous clots and blockages. According to the American Heart Association, some 50 million Americans suffer from hypertension, most without knowing it. The good news is early intervention can help lower and control blood pressure.

Another old school heart remedy, magnesium addresses hypertension by helping to maintain proper smooth muscle function in your blood vessels, according to Stephen Sinatra, N.D., the added magnesium also acts like a calcium channel blocker to stabilize cardiac conduction, heart muscle and vascular membranes. Research is in magnesium’s corner.

A 2000 Journal of Hypertension article explained magnesium supplementation prevented blood pressure elevation in an animal model of induced hypertension; the authors associated the effect with the inhibition of platelet calcium uptake and decreased intercellular free-calcium concentration.⁶⁴ The mineral might also help heart patients by way of reduced stress. Studies have shown stress, as well as anxiety and depression, can contribute to heart disease progression,^65,66,67 while traumatic events can trigger arrhythmia and heart attacks.^68,69 Magnesium deficiency has been found in stress cases,^70,71 which can be reversed with magnesium supplementation.⁷²

“Magnesium is something that most people’s bodies need and can be essential in helping to prevent hypertension before it begins and to treat it naturally with less reliance on drugs,” said Jay Cohen, M.D., “If magnesium were properly included in the mainstream medical approach to hypertension, it would save people hundreds and health-care systems millions of dollars a year.”

The cornucopia of cardio care products is boosted by positive scientific conclusions, but the sheer volume of products in the category has many consumers confused. “Heart disease is a subject full of misinformation,” quipped Ken Whitman, director of marketing for Peter Gillham’s Natural Vitality.

“They understand that key factors in maintaining cardiovascular health are a heart healthy diet, smoking cessation, maintaining healthy lipid levels, maintaining low blood pressure, increasing physical activity, weight loss and managing diabetes,” stated Beeta Little, director of product development and technical services for BlueBonnet Nutrition. “However, they may not be privy to some of the more recent cutting-edge supplements to hit the market.”

The situation is not helped by the information gap caused by undereducated practitioners, according to Weiss, who stated: “The heart health case model is a mess. You have conventional doctors who don’t know anything about natural medicine, and you have naturopathic doctors who know too little about drugs. This will take a very long time to fix.”

“Unfortunately, there are many forms of heart disease, and consumers are not as well-educated as they could be about how best to supplement their health according to disease type,” Trautman noted. “Consequently, we believe that there should be more education in this area, with guidance being provided on which heart health supplement is beneficial for each specific heart condition.” To this end, companies like Bioriginal provide retailers with the educational tools they need to effectively convey the actions and benefits of various heart health products.

Among the methods to improve heart category sales in-store, Little suggested window and end-cap displays, heart health product sections and shelf talkers/projectors that identify a particular product as a “heart-healthy” product within a branded block section. “Heart-healthy promotions with displays and literature can effectively attract consumer interest, especially during February, which is Heart Health month,” she added. “Offering blood pressure and cholesterol screenings especially during February and announcing such screening ahead of time in newsletters, store flyers and ads in local papers is another way to draw consumers into your store to sell them on heart-healthy product(s) that will suit their individual needs.” Best-selling books on heart-health and offering gift baskets/ bags with an assortment of heart-healthy products as Valentines gift ideas were also in her bag of merchandising tips.

Another question facing retailers in this category is what to stock in the heart health category and how to best guide consumers to the right products. “Among the top five most popular heart health supplements are fish and plant oils, which are seeing growth rates of 40 percent and 27 percent per year respectively,” Trautman reported. Little echoed the good news on EFAs, stating heart health product sales are up over last year, especially in the omega-3 fish oil, carnitine and CoQ10 categories.

Identifying and redirecting consumers to the heart section is simple, Little assured. “Customers will usually identify themselves as having cardiovascular issues (e.g., high blood pressure, high cholesterol levels, etc.), making it easy for retailers to point them in the right direction,” she reasoned. “However, customers coming in to a natural food store who are overweight or over 40 are also good potential candidates for preventive heart-healthy products.”

There is little doubt of the growing popularity of natural heart remedies, especially as consumers grow increasingly wary of traditional pharmaceutical treatments and their side effects. “There is a growing understanding that what we were told was going to be better living through chemistry didn’t necessarily turn out to be the case,” Whitman said.

Trautman contends these disgruntled consumers are turning to natural heart remedies in droves “According to the Natural Marketing Institute’s findings, 45 percent of adults are concerned with preventing heart disease, statistics which are reflected in the $1 billion heart health supplements market,” she said.

The magnitude of the heart health arena is too great, both health-wise and sales-wise, to misfire at the retail level. There are mountains of research results, contraindications, natural product offerings and educational concerns to climb, but the view from the top is a healthier world and a healthier store.

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