A comprehensive cardio-health functional food, beverage or supplement should contain nutritional ingredients that target a combination of symptoms—cholesterol, blood pressure, arterial health and more. Todd Runestad, science editor at Functional Ingredients, gives the scoop on the the best ingredients for the ticker.

The cardiovascular system is the body’s red river, a veritable waterway of blood that is ferried by arteries and veins from its pumping station, the heart, throughout the body, delivering oxygen and nutrients to cells and transporting waste away. But if this red river becomes polluted, the result can be fatal: More than one of every three people dies of heart disease.

As they say, crisis equals opportunity, and the cardio-health market is ripe for nutrition solutions to help maintain and regulate a healthy cardiovascular system by keeping triglycerides, blood pressure and cholesterol levels in check as well as improving arterial health.

Nutrients can help address all of these symptoms. Between Jan. 1 and Sept. 23 of 2008, 134 new functional-food and -beverage products targeting cardiovascular health were launched in the United States, according to Mintel’s Global New Products Database.

The easy target is cholesterol levels. Doctors routinely counsel patients to keep cholesterol levels under 200 mg/dL, but the inconvenient truth is that about an equal number of people with cholesterol under 200 as above die from cardio events. In a 2007 Lancet paper, a Harvard physician described how no studies have shown cholesterol-lowering statin drugs to be effective for women at any age, nor for men 69 or older, who do not already have heart disease or diabetes. Indeed, studies show between 45 percent and 60 percent of patients hospitalized for a heart attack have a “normal level” of cholesterol.

Calcium check
So if cholesterol won’t necessarily give you a heart attack, what will? According to a 2007 study at the Cooper Clinic in Texas, the answer may be calcium. After controlling for other factors among 303 patients, those with a coronary artery calcium score of less than 10 had only a 1.7 percent likelihood of ischemia, or decreased arterial blood flow. For those with higher levels of calcium, the likelihood was 20 percent.

Some studies have shown that coronary calcium content is a good predictor of future coronary events in both symptomatic and asymptomatic populations. However, other studies have shown that some patients with acute coronary syndromes have little or no coronary calcium.

K2 summiting
If calcium-rich plaque deposits are indeed the harbinger of doom, then one answer is surely vitamin K2. Only relatively recently has vitamin K2 been found to activate proteins responsible for calcium utilization in bones. K2 activates matrix GLA protein, a prime inhibitor of vascular calcification. The upshot is a blockbuster nutrient that removes calcium from arteries, where it is not needed, and places calcium in bones, where it is.

People who consume the highest amounts of vitamin K from dietary sources such as spinach and broccoli exhibit more than a 50 percent reduction in coronary heart disease mortality and aortic calcium scores.

In a recent animal study, K2 supplementation reduced accumulated arterial calcium deposits and enhanced arterial elasticity. In human models, 45 mcg per day of vitamin K2 is seen as an efficacious dose. Once sold only as a supplement, K2 is becoming available for the food market this year.

Omega-3s from fish oils
To deal with calcium in the arteries, fish oils ease the stickiness of blood platelets. This makes the blood slide more smoothly past plaque deposits so that a chunk of plaque is less likely to break off and cause a sudden-death heart attack. A recent meta-analysis of omega-3 fatty acid trials shows fish oils reduce coronary heart disease mortality by 36 percent and total deaths by 17 percent.

Epidemiologic and clinical trials have shown that omega-3s reduce CVD incidence. Omega-3s can also prevent arteriosclerosis by inhibiting the development of plaque and blood clots that can clog arteries. They can decrease risk of arrhythmias, which can lead to sudden cardiac death; decrease triglyceride levels and the growth rate of atherosclerotic plaque; and can reduce blood pressure in individuals with hypertension. They’re also one of the few nutrients that can raise HDL (good) cholesterol.

The ideal dosage of omega-3s isn’t clear. There is no official recommended daily amount, though industry groups are pushing for that. Studies suggest that taking between 0.5 g a day to 1.8 g a day of omega-3s that contain both EPA and DHA (fish oils) significantly reduces deaths from heart disease and all causes. For the omega-3 alpha-linolenic acid (from flax and other sources), a total intake of 1.5 g a day to 3 g a day seems beneficial. Even the staid American Heart Association recommends healthy people consume about 1 g a day of omega-3s with EPA/DHA. For those who need to lower triglycerides, the AHA recommends 2 g to 4 g a day.

Addressing cholesterol
The power of allopathic medical doctors in Western societies telling patients that heart disease is all about keeping cholesterol levels lower than 200 mg/dL is difficult to trump, so despite the evidence presented earlier, we’ll go with the flow and discuss strategies for keeping cholesterol levels in check.

Niacin is the king of lowering cholesterol. It is the most potent drug available for lowering plasma levels of triglycerides and increasing HDL cholesterol. Even statin drugs are effective only in lowering LDL, and the pharmaceutical industry advocates taking niacin concurrently with statins. Therapeutic doses of niacin range between 1,000 mg and 1,500 mg a day, whereas the recommended daily allowance is 14 mg to 16 mg a day, and food product developers are hard-pressed to add any more than that.

Sterols and stanols are derived from natural vegetable oils such as corn and soy. At dosages of 0.8 g a day, sterols and stanols have an FDA health claim to lower cholesterol levels by reducing cholesterol absorption.

Studies show that 1.3 g a day of plant sterol esters or 3.4 g a day of plant stanol esters in the diet are needed to show a significant—10 percent—cholesterol-lowering effect. In order to qualify for this health claim, a food must contain at least 0.65 g of plant sterol esters per serving or at least 1.7 g of plant stanol esters per serving.

Sterols’ and stanols’ effects are enhanced with diet or drug interventions: Eating foods low in saturated fat and cholesterol and high in stanols or sterols can reduce LDL by 20 percent, and adding sterols to statin drugs is more effective than doubling dosages of the drugs. A product health claim must specify that the daily dietary intake of plant sterol esters or plant stanol esters should be consumed in two servings eaten at different times of the day with other foods.

Red-yeast rice molecules happen to be bioidentical to statin drugs, making them effective, scientifically, in lowering LDL cholesterol levels. But from a regulatory standpoint, statins arrived on the market first and any subsequent supplement is out in the cold. Products containing red-yeast rice cannot suggest in any way that they are useful for heart health. For supplements, at least, savvy retailers know the score and shelve red-yeast rice products in their cardio-health section (wink, wink). Some products contain only red-yeast rice, while others make it easier for consumers by combining the rice with other ingredients perceived to be heart healthy, such as fish oils. A recent Mayo Clinic randomized 12-week trial found a combination of red-yeast rice and fish oils were just as effective as statin drugs for lowering LDL cholesterol.

Soy is the poster child for the market benefits an ingredient can have once it receives an FDA-minted health claim. Lately, however, soy’s fortunes have fallen as its efficacy in lowering cholesterol levels has come into question. If nothing else, soy consumption can improve blood lipids because soy often replaces the harmful fats that would otherwise be consumed in red meat.

Blood pressure and beyond
Coenzyme Q10 ought to be prescribed every time a physician writes a ’scrip for statin drugs, which deplete the heart of the nutrient. Co-Q10 boosts mitochondria, the cell’s power plant, and it accumulates in particular in the heart.

What’s more, it can lower blood pressure. In a six-month, placebo-controlled trial with 74 diabetic patients, 200 mg a day of Co-Q10 lowered blood pressure. A similar 12-week human trial with 74 diabetics found 200 mg a day of Co-Q10 improved blood pressure and long-term glycemic control.

Dairy makes a prime functional-ingredient delivery system for all manner of health benefits. Milk proteins, peptides, probiotic bacteria, calcium and other minerals can significantly reduce blood pressure. Fermented dairy products and probiotic bacteria decrease the absorption of cholesterol. A yearlong 2008 human study investigating whether a glycomacropeptide-enriched whey supplement could promote satiety and weight loss more than skim milk found no significant difference on weight loss. However, researchers did discover the whey led to decreases in total and LDL cholesterol, triacylglycerols, glucose, insulin, and systolic and diastolic blood pressure after both six and 12 months, as well as increases in HDL cholesterol at 12 months.

Whole grains are marketed to great benefit in cereals and breads. In the Nurse’s Health Study, those who had a median intake of 2.7 servings of whole grains a day experienced half the risk of ischemic stroke and a 30 percent risk reduction of coronary artery disease. Another study found those with the highest fiber intake had the lowest diastolic blood pressure.

OPCs (oligomeric procyandins) are some of the most abundant polyphenolic substances in the plant kingdom. OPCs such as grapeseed extract and crataegus, or hawthorn, have vasodilatory and blood pressure-modulating effects.

Pycnogenol, French maritime pine bark, is another form of OPC that has been shown to help relax the vasculature and enhance microcirculation by increasing capillary permeability.

Sodium is finally being fingered by regulators as the agent causing high blood pressure and other forms of cardiovascular assault. But a February study that confirmed sodium raises blood pressure also found it helps blood vessels relax, which reveals another angle to sodium’s role in cardio health.