Still Beating Strong

A great deal is asked of the heart, both abstractly and physically. A mere pump, the heart helps push nutrient- and oxygen-rich blood throughout the body and performs this primary task faithfully and rhythmically for decades. It is the very definition of a loyal worker. However, its efficiency, consistency and longevity rely on a healthy cardiovascular system, and this is where people can run into problems over time.

Aside from some genetically linked structural and functional issues, the heart is a happy, healthy pumper as long as the blood is flowing freely throughout the body's network of veins and arteries. Any number of situations along this vascular journey can reduce blood flow to the heart and result in heart damage or death. Unfortunately, such problems are common. Heart disease is the leading cause of death in the United States, despite a recent decline in heart-related deathscardiovascular disease (CVD) death rates declined 31 percent from 1998 to 2008 (Circulation. 2012 Jan 3;125(1):e2-e220.). Still, about every 25 seconds, someone has a coronary event, and one person dies of a coronary event each minute, according to the American Heart Association (AHA). To put the disease prevalence in simple prospective, AHA has reported more than one in three adults has some form of CVD. The problem isn't just American.

"CVD kills more people worldwide than any other disease," said Stephen Moon, CEO, Provexis and Science in Sport. "Indeed, experts estimate that by the year 2020, nearly 40 percent of all deaths worldwide will be due to CVD, more than twice the percentage of deaths from cancer."

The reason why heart disease is so prevalent is the same reason why the heart health product market is huge and still expanding. Dietary and lifestyle choices are the root of most CVD. AHA said 80 percent of heart disease and stroke is preventable. A healthy diet, consistent exercise and smoking cessation are among the top ways to prevent heart problems or improve risk factors such as hypertension, high cholesterol, high blood sugar and excess body weight.

Consumers are motivated by quality of life, but also spring into action when conventional treatment becomes a financial burden. "About 37 percent or nearly 125 million Americans have heart diseases," added Bryan See, regional product manager, Carotech Inc., citing AHA sources. "In the same report, health care cost for heart disease will rise from US$273 billion to US$818 billion in conjunction with the increase of heart disease cases to 41 percent by 2030." The goods news, he assured, is that both drugs and supplements can help consumers fight certain heart diseases.  "Those concerned with the side effects associated with pharmaceuticals, such as statin drugs for cholesterol, are looking for alternative medicines such as heart-health supplements like fish oil, phytosterols, tocotrienols, CoQ10, etc."

"The heart health market is estimated to grow by approximately 20 percent per year for the next several years," noted Heather Thompson, global marketing, communications, Stratum Nutrition. "Several factors are responsible for this growth: an aging population that demands a higher quality of life in their senior years; growing consumer awareness of heart health indicators; and the consumer trend toward maintaining a healthy lifestyle in order to minimize illness onset."

Pam Stauffer, marketing manager, Cargill, reported the United States makes up the largest single heart health food and drinks market, capturing around two-thirds of the overall sector ($6.8 billion in 2009) and is forecast to reach $10.5 billion by 2015. "The high prevalence of CVD and associated risk factors, such as hypertension, has created a consumer base willing to use food and drink products that are specifically designed to aid heart health," she said. " According to [the Natural Marketing Institute], nearly three-in-four consumers report usage of heart-healthy foods and beverages. This trend has remained stable since 2005."

The consumer base for natural heart health products tends to be older, and this demographic may be poised to contribute some big growth to the sector. "The demographic of the elderly /baby boomers is increasing," See noted.

William Loh, vice president of marketing, Cargill, agreed consumer perception and focus on cardiovascular health increases with age, and the aging U.S. population will drive preference toward foods that promote cardiovascular health. 

Moon confirmed the aging U.S. population is definitely contributing to an increase in sales of heart-healthy food, beverages and dietary supplements. "Indeed, more consumers are turning to functional products to help them stay healthy as they grow older."

As heart product companies jockey to gain a profitable share of the increased number of consumers seeking help, the market is getting a boost from public health efforts to increase awareness. "Governments, health professionals and the health-oriented media have consistently pressed the message on the importance of cardiovascular health, leading to increased consumer awareness of the consequences of CVD," Moon said. "This awareness is one of the primary factors driving market growth."

The depth of the awareness of heart health may be the next necessary focal point. "Many in the public fail to realize the interconnectedness of seemingly unrelated symptoms, such as elevated blood glucose levels, continuous high blood pressure or abdominal tissue accumulation, with future CVD," said Paul Dijkstra, CEO, InterHealth USA. He explained while awareness is the first step in supporting a healthy heart, consumers need to understand it takes a multifaceted approach to supporting heart health. "A combination of weight reduction, healthy diet, moderate and regular exercise, and science-backed dietary supplements and functional food and beverages may help maintain heart health."

Looking back, Dijkstra sees a heart-health category that has undergone somewhat of a revolutionary process during the past decade. "There is an interrelated triage of consumer interest, product activity and manufacturer intent," he said. "Along with the increased interest and awareness on the consumer and professional sides about the importance of supplementationusing nutraceuticals as well as functional foods and beveragesfor maintaining a healthy cardiovascular system, manufacturers have significantly increased their research activities developing new compounds and new product forms much to the liking of consumers. This has lead to an increase in category growth."

Moon said more than half of Americans use supplements on a daily basis, according to the Centers for Disease Control and Prevention (CDC). "The United States is one of the key global markets for dietary supplements," he noted. "In terms of sub-segments, heart health is one of the most lucrative areas, with many consumers taking supplements to keep their hearts healthy." That said, he acknowledged fortified foods and beverages, which are easy to incorporate into daily life, are also growing in favor with health-conscious U.S. consumers. "Everyday products that feature naturally derived ingredients with proven health benefits are particularly popular," he said. "Some examples include spreads fortified with plant sterols, breads with high levels of fiber and beta-glucans and ready-to-drink beverages formulated with naturally derived, scientifically substantiated ingredients such as Fruitflow." Citing convenience as a key differentiator for busy consumers, he predicted "healthy shot" products will continue to grow in popularity. DSM, one of Provexis commercial partners, has used Fruitflow, a whole tomato extract designed to improve blood flow, in such a product to help prevent deep vein thrombosis on long-haul flights, according to Moon.

Thompson reported todays consumers are actively seeking convenient" supplementation, which most  view to be in the form of food and beverages, whenever possible, rather than taking pills. "This trend has fueled innovation within the industry, and resulted in wide varieties of delivery methods," she noted. "We continually work in our application labs to test viability of new applications in supplement, food and beverage, whether that be a chewable, baked good, snack, drink sachet, gum or other 'convenient' new ways to supplement our heart-healthy fiber."

"Some heart-health shoppers love the convenience of dietary supplements, while others seek food and beverage alternatives," Stauffer said, noting this dichotomy can be positive for those businesses, like Cargill, that work with both dietary supplement manufacturers, and food and beverage manufacturers. "Products made with CoroWise® plant sterols range from dietary supplements such as Cardio Chews®, to many foods and beverages such as Smart Balance® Heart Right® milk and Corazonas chips and oatmeal squares."

Count Dijkstra among those seeing food and beverage applications as a key heart-health growth category, as he noted there is continuing product activity for heart-health food and beverages. Still, versatility might be the important characteristic in this dynamic health segment. "Market success for heart-health nutraceutical ingredients lies strongly in its application for dietary supplement, food and beverage markets," he reasoned.

In the growing market of natural heart-health ingredients, market success will also require differentiating a product from the crowd. "Consumers have many heart-healthy food, beverage and supplement choices," Stauffer said, noting Cargill continues to see demand for new product development with plant sterols. Working with customers on many levels can help ensure success, she suggested. "We conduct primary marketing research to enable sharing of proprietary consumer insights for consideration in developing product labels," she said. "Cargill also offers marketing support to co-brand customer partners via an extensive health care professional outreach program."

In a market segment saturated overall, one way to find a profitable niche may be focusing on a specific area of function and benefit. "Although manufacturers face increasing competition, there are definitely some emerging sub-segments, which offer much potential," Moon reported. "The market for ingredients promoting healthy blood circulation, for example, is still relatively underdeveloped, with less than a handful of technologies available." One way Proxexis has differentiated its Fruitflow product is via regulatory clearances including health claims approval and generally recognized as safe (GRAS) status.

Moon said the ingredient, which was licensed to DSM Nutritional Products in 2010, was the first to receive an Article 13(5) claim from the European Safety Authority (EFSA) and has gained GRAS status in the United States, enabling it to be used in foods. Opening up the options for varied applications and the ability to explain the health benefits in more direct language can help heart-health product formulators lift their finished product above the crowd.

"The ingredient is currently available in an easy-to-use syrup format for use in beverages, spreads and dairy products, with a powder format for dietary supplements currently in the final stages of development," Moon explained. "Additionally, scientists from Provexis sports business, Science in Sport (SiS), are currently looking into the use of Fruitflow in sports applications."

See agreed product and formula differentiation are key to compete and ensure a particular product does well in the market. He sees the solution to the saturation dilemma is a synergistic combination with clinically proven functional ingredients for heart health. As an example, he said, "Tocotrienols as a potent form of natural vitamin E allow it to be combined in a synergistic manner (based on science) with many other heart health phytonutrients."

Combining ingredients that address complementary aspects of heart health is one method of differentiation, and another way may be developing ingredients that address such issues on their own. "Many of the ingredients used in heart-health products only address one or two heart-health issues such as blood pressure or cholesterol," claimed Dijkstra, who stressed it is important for manufacturers to look at the bigger picture when it comes to cardio health. "Manufacturers are increasingly interested in offering solutions to their customers that address particular health concerns from a holistic or a 'whole body' perspective that target several underlying mechanisms simultaneously and see the body in its entirety," he explained. "Managing cholesterol levels and high blood pressure definitely helps support a well-functioning cardiovascular system, but often overlooked is the impact of blood sugar management on the heart and vascular system."

Thompson touted focused, scientific support as a top differentiator for its ARTINIA, a chitin-glucan fiber shown to target oxidation of low-density lipoprotein (LDL), an increasingly recognized precursor and predictor of CVD. "The heart-health market is ever changing, due to ongoing discoveries about our cardiovascular system and how it functions," she said. "As we discover new biomarkers that correlate to the function of our cardiovascular systems, we develop better supplements for supporting heart health."

Thompson's colleague Joseph Evans, Ph.D., manager of pharmacology and a research fellow for Stratum, called scientific substantiation a cornerstone of the company. "In todays regulatory environment, in the United States and internationally, our customers demand to know the clinical basis upon which they can substantiate the claims for our ingredients," he explained. "In the past, it was often sufficient to base claims on biochemical, cellular or animal data. Today, these types of studies are best described as supportive, but not sufficient. Stratum believes it is paramount to obtain clinical data in the target population using the actual dose of the ingredient to be marketed, and publish the findings in a top-tier scientific journal. Any deviation from this approach would be a disservice to our customers, and leave lingering the question of whether our ingredients are really as safe and effective as we claim." 

Clinical research is a compelling part of an ingredient brands story, according to Stauffer. "Plant sterols are backed by more than 50 years of clinical research and eligible for an FDA health claim," she added, noting such support can help bring credibility to the value proposition of an ingredient and product.

Clinical trials combined with solid research and development (R&D) commitment is important to develop a product and formulation that works and is able to confer the health benefits to consumers, See offered. "We put significant emphasis on R&D to ensure we are always ahead of the curve in terms of product formulation as well as research," he assured.

For more on Heart Health ingredients and the market, visit INSIDER's Heart Health Content Library.