Cardiovascular diseases affect nearly half of American adults and are the No. 1 cause of death globally. According to the American Heart Association (AHA), in 2017, coronary heart disease was the leading cause (42.6%) of deaths attributable to cardiovascular disease in the United States, followed by stroke (17.0%), high blood pressure (10.5%), heart failure (9.4%), diseases of the arteries (2.9%), and other cardiovascular diseases (17.6%) (Virani et al. 2020).
When it comes to heart health, blood pressure, cholesterol, and triglycerides are some of the top factors that can increase the risk of heart disease. However, these can be managed through diet, exercise, prescription medicines, and lifestyle changes. Mediterranean and DASH diets are often encouraged for heart-healthy lifestyles. These promote fruits, vegetables, whole grains, nuts, legumes, and fish as well as limiting sodium, processed meats, and saturated fat.
Here is a look at some of these foods and rising ingredients that research shows may play potential roles in controlling these risk factors and in maintaining heart health.
Whole grains are sources of many nutrients, from vitamins and minerals to dietary fiber and phytochemicals. All of these may help contribute to the heart benefits exhibited by whole grains, including affecting cholesterol and blood pressure and managing weight. Obesity is one of the leading causes of heart disease, so the role of whole grains in weight loss is ultimately beneficial for the heart. Roager et al. (2019), for example, showed that a whole grain diet reduced body weight and inflammatory markers in adults at risk of developing metabolic syndrome compared to a refined grain diet. The reduction in body weight was directly associated with lower energy intake, suggesting that whole grains are more satiating.
A 2018 evidence paper for New Zealand’s Heart Foundation reviewed research on whole grains and heart health (Gorton 2018). The authors stated that “observational research suggests three [servings] of whole grains per day are associated with heart health benefits, and there are likely to be additional benefits with higher intakes. Whole grains may be useful for people needing to lower their cholesterol levels to reduce cardiovascular risk, as randomized controlled trials showed small reductions.” They also found that higher whole grain and bran intakes were consistently associated with a 16%–30% lower risk of cardiovascular disease in observational studies. In addition, oats and barley had a greater beneficial effect on total and LDL cholesterol, especially in people with raised lipid levels.
Campbell and Fleenor (2018) suggested a potential role of whole grains in protecting against aortic stiffness. In the study, which involved 22 obese men, whole grain consumption was negatively correlated with obesity-associated aortic stiffness, a predictor of future cardiovascular events. In addition, while fiber content has been proposed as a major beneficial component in whole grains, the results showed that it did not correlate with obesity-related aortic stiffness, suggesting whole grains may have a unique and potentially synergistic role in the protection of obesity-associated aortic health.
Fish high in omega-3 fatty acids include salmon, mackerel, herring, lake trout, sardines, and albacore tuna. AHA recommends eating 2 servings of fish per week as part of a heart-healthy diet. The omega-3 fatty acids linked to heart health are alpha-linoleic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). Various studies have shown that omega-3s can reduce triglycerides, reduce the risk of developing an irregular heartbeat, and slow the build-up of arterial plaque. Hu et al. (2019) demonstrated that marine omega-3 supplementation lowered risk for myocardial infarction, coronary heart disease (CHD) death, total CHD, cardiovascular disease (CVD) death, and total CVD. This meta-analysis of 13 trials reports that risk reductions appeared to be linearly related to marine omega-3 dose.
Olive oil is the most-recognized heart-healthy oil among consumers, but for the food industry, more stable oils are often needed in formulations. High oleic oils can offer the stability food developers need. They also have a heart-healthy halo. High oleic oils received a U.S. Food and Drug Administration (FDA) Qualified Health Claim in November 2018 stating that, “supportive but not conclusive scientific evidence suggests that daily consumption of about 1.5 tablespoons (20 g) of oils containing high levels of oleic acid may reduce the risk of coronary heart disease. To achieve this possible benefit, oleic acid-containing oils should not increase the total number of calories you eat in a day. One serving of [x] oil provides [x] grams of oleic acid (which is [x] grams of monounsaturated fatty acid).” This claim includes edible oils that contain at least 70% of oleic acid per serving, including high oleic sunflower oil, high oleic safflower oil, high oleic canola oil, olive oil, and high oleic algal oil.
“The FDA based its decision on research that suggested a relationship between consuming oils with high levels of oleic acid and improved cholesterol levels, which it said indicated a reduced risk for coronary heart disease,” says Patricia Williamson, principal scientist, scientific and regulatory affairs, at Cargill. “The agency noted the studies it reviewed only showed beneficial heart effects when the oleic acid–containing oils replaced fats and oils that were higher in saturated fats.”
Cargill offers a high oleic sunflower oil and an organic high oleic sunflower oil that could be included in the FDA’s qualified health claims. “These oils, which are low in saturated fat, offer a number of other benefits, including high stability, superior performance, longer fry life, and a neutral flavor,” says Bethany Rahja, commercial analyst, global edible oils solutions, North America, Cargill. “They are well suited for a range of applications, including fries, frozen meals, bakery, snacks, sauces, and dressings.”
“According to AHA guidelines, reducing saturated fat intake and replacing with unsaturated vegetable oil reduces cardiovascular disease by approximately 30%—an effect similar to cholesterol-lowering statin drugs,” says Tyler Groeneveld, commercial grains and oils leader for North America at Corteva Agriscience. Corteva Agriscience provides farmers around the world with a balanced and diverse mix of seed, crop protection, and digital solutions.
“Omega-9 Canola Oil and Plenish high oleic soybean oil seeds (Corteva Agriscience) have been bred to create a profile that has increased monounsaturated fat, high stability, and functionality,” explains Groeneveld. The unique fatty acid profile in Omega-9 Canola Oil was developed through traditional plant breeding, providing food companies with a Non-GMO Project Verified option. Plenish is a high oleic soybean oil with a healthy oil profile and increased oil stability. It has 0 g of trans fat, has less saturated fat, and has among the highest amounts of heart-healthy monounsaturated fat available in soy. It has an oleic content of more than 75%.
Both Omega-9 Canola Oil and Plenish high oleic soybean oil contain monounsaturated fatty acids, which have been associated with important health benefits such as lowering the risk of heart disease by improving risk factors. They may also help improve the function of blood vessels. “These high oleic oils are naturally stable without hydrogenation,” says Groeneveld. “Additionally, the stability of Omega-9 Canola Oil and Plenish allows packaged foods to stay fresh without additives or artificial preservatives, enabling the clean labels consumers demand. This also helps lessen food waste, which is a growing global concern.”
Phytosterols aid in the lowering of total and LDL cholesterol by blocking and slowing the absorption of cholesterol. A safe and effective dose is 2–3 g of phytosterols. Reaver et al. (2019) showed that supplementation with phytosterols in a new dietary supplement formulation efficiently and safely decreased LDL cholesterol concentrations by 10.2%. The primary objective of this study was to determine the impact of a phytosterol emulsion for dietary supplements (1.5 g/day of phytosterol equivalents) on LDL cholesterol concentrations.
The phytosterol source used in the study was Vegapure 95E from BASF. This form is intended for use in dietary supplements such as soft gelatin capsules or liquid preparations but can also be used in margarine and dairy products. BASF’s Vegapure ingredients are water and oil dispersible and suitable for a wide range of dietary supplement, beverage, and food applications. For example, Vegapure WDP products are suitable for beverages, dietary supplements, instant powders, and baked goods.
Walnuts, almonds, and pistachios are associated with heart benefits. Walnuts are a rich source of ALA (2.5 g per oz), which has anti-inflammatory effects, according to the California Walnut Board. Research has shown that walnut consumption may help lower LDL cholesterol and diastolic blood pressure. Almonds are cholesterol-free and have 1 g of saturated fat and 13 g of unsaturated fat per 1 oz serving, while pistachios are a source of antioxidants, including vitamin E, polyphenols, and the carotenoids lutein and zeaxanthin. Pistachios have also been shown to support healthy cholesterol levels and lower blood triglyceride levels.
A meta-analysis by Becerra-Tomás et al. (2019) showed a beneficial role of nut consumption in reducing the incidence of, and mortality from different CVD outcomes. The results revealed an inverse association between total nut consumption and CVD incidence, CVD mortality, CHD incidence, CHD mortality, stroke mortality, and atrial fibrillation.
Lycored found that healthy blood pressure is the top cardiovascular wellness goal of consumers. The company surveyed 505 adults in the United States and the United Kingdom, all age 50 and older, which is the demographic most likely to purchase supplements for cardiovascular health (CVH). Nearly seven in 10 (68%) ranked healthy blood pressure as one of the three CVH goals they most wanted to achieve. Healthy blood cholesterol levels (61%), healthy arteries (55%), and a healthy circulatory system (45%) also scored highly.
Lycored offers a patented standardized tomato extract that it says is heart healthy. Most recently, Wolak et al. (2019) demonstrated that the standardized tomato extract was linked to significant reductions in blood pressure in people with hypertension. The extract is the basis of Cardiomato, Lycored’s proprietary mix for cardiovascular supplements to help reduce levels of oxidized LDL cholesterol. In the study, the researchers aimed to find effective doses of Lycored’s Tomato Nutrient Complex (lycopene, phytoene, and phytofluene) to maintain normal blood pressure in untreated hypertensive individuals. The results suggested that only carotenoid levels achieved by the Tomato Nutrient Complex dose of 15 mg of lycopene or higher correlate to a beneficial effect on systolic blood pressure in hypertensive subjects while lower doses and lycopene alone do not.
Another ingredient, Fruitflow from DSM is derived from tomato concentrate and is a water-soluble, highly concentrated form of bioactives that contain more than 30 known antiplatelet compounds. Fruitflow is extracted from the jelly around the seeds in sun-ripened tomatoes. The selected tomatoes are crushed to a paste, and then the skin and seeds are removed. The bioactive compounds responsible are extracted from the clear juice and then highly concentrated. Fruitflow promotes healthy blood flow by keeping blood platelets smooth to avoid aggregation inside blood vessels.
In addition to promoting good blood flow, there is initial scientific evidence to support the effect of Fruitflow on blood pressure. In a pilot study, Uddin et al. (2018) demonstrated Fruitflow’s effects on high blood pressure and platelet hyperactivity in a study with 12 pre-hypertensive people. The findings of the study showed that consuming a single dose of 150 mg of Fruitflow resulted in a significant reduction in 24-hour average blood pressure and average wake-period and sleep-period systolic blood pressure, compared to consuming the placebo.
Aronia berry, also known as chokeberry, contains a high concentration of anthocyanins. “The tremendous health benefits, including the heart health benefits observed from supplementing with aronia berry are believed in large part to be due to its loaded polyphenol profile,” states Melanie Bush, chief science officer at Artemis. “Even among other high-antioxidant berries, aronia is particularly high in flavonoids such as anthocyanins and proanthocyanidins. In several human studies, the benefits were observed after treatment with anthocyanin-standardized aronia extracts.”
Rahmani et al. (2019) demonstrated a significant increase in HDL cholesterol and reduction in total cholesterol and LDL cholesterol among subjects supplementing with aronia. They analyzed seven studies in the meta-analysis. A more recent meta-analysis conducted at the Franklin School of Integrative Health Sciences (manuscript submitted for publication) showed that 6–8 weeks of aronia supplementation caused a measurable reduction in overall cholesterol and systolic blood pressure with the strongest effect among adults age 50 and older, according to Artemis.
Interestingly, aronia supplementation lowered systolic blood pressure but had little effect on diastolic blood pressure. “The fact that systolic blood pressure is reduced, but not diastolic blood pressure, indicates that clinically speaking, aronia is targeting what is most problematic without lowering all blood pressure across the board and potentially disrupting overall health,” explains Bush. “Whereas pharmaceuticals tend to reduce blood pressure all together without discernment, the results of aronia supplementation indicate more of a normalizing effect, which tends to be a trend with high-anthocyanin berries and their ability to support a healthy balance within the body.” Bush adds that while the recent meta-analysis did not make an overall conclusion on recommended dosage, some of the studies that were evaluated as part of the analysis used treatment dosages in the range of 45 mg—60 mg of aronia anthocyanins.
A patented grape seed extract, MegaNatural-BP from Polyphenolics has been clinically shown to benefit blood pressure maintenance and the flexibility of blood vessels. Research using animal models indicates that it activates the enzyme nitric oxide synthase to produce nitric oxide. Nitric oxide is a gaseous compound that acts as a cellular messenger, and when present in the inner lining of the blood vessels (endothelium), it causes the surrounding smooth muscle to relax, supporting healthy blood flow.
Three clinical studies demonstrate MegaNatural-BP’s support of healthy blood pressure within the normal range and that the polyphenols found in MegaNatural-BP may maintain the elasticity of healthy blood vessels. For example, Park et al. (2016) showed that the blood pressure of study subjects who consumed the grape seed extract ingredients in a beverage form for six weeks dropped to normal ranges. But four weeks after the study, without consuming MegaNatural-BP, their blood pressure had risen back to prehypertension range.
Hytolive Olive Fruit Polyphenol from PLT Health delivers hydroxytyrosol, a 100% natural, patented solvent-free natural extraction of olive polyphenols from the by-product water of olive oil production. The primary constituent of Hytolive is hydroxytyrosol, an olive polyphenol that has potent natural antioxidant activity. In 2012, the European Food & Safety Authority accepted that hydroxytyrosol acts as a protector of the cardiovascular system, avoiding oxidation of LDL cholesterol by free radicals, maintaining normal blood HDL cholesterol concentrations, and preventing atherosclerosis. For food and beverage formulations, Hytolive is considered GRAS and can appear on labels as “olive fruit” or “olive fruit polyphenols.”
Interestingly, PLT Health says that Hytolive is an ideal co-ingredient in omega-3 formulations, particularly those that contain fish oil. The two have different mechanisms of supporting heart health and the antioxidant properties of hydroxytyrosol can protect fish oil and omega-3s from oxidation.
Next month’s Nutraceuticals section will discuss formulating foods with nuts and seeds.
Becerra-Tomás, N., I. Paz-Graniel, C. W. C. Kendall, et al. 2019. “Nut Consumption and Incidence of Cardiovascular Diseases and Cardiovascular Disease Mortality: A Meta-analysis of Prospective Cohort Studies.” Nutr. Rev. 77(10): 691–709.
Campbell, M. S. and B. S. Fleenor. 2018. “Whole Grain Consumption is Negatively Correlated with Obesity-associated Aortic Stiffness: A Hypothesis.” Nutr. 45: 32–36.
Gorton, D. 2018. Whole Grains and the Heart. Heart Foundation, https://www.heartfoundation.org.nz.
Hu, Y., F. B. Hu, and J. E. Manson. 2019. “Marine Omega-3 Supplementation and Cardiovascular Disease: An Updated Meta-analysis of 13 Randomized Controlled Trials Involving 127, 477 Participants.” J. American Heart Assoc. 8(19): e013543.
Park, E., I. Edirisinghe, Y. Choy, et al. 2016. “Effects of Grape Seed Extract Beverage on Blood Pressure and Metabolic Indices in Individuals with Pre-hypertension: A Randomised, Double-blinded, Two-Arm, Parallel, Placebo-controlled Trial.” Br. J. Nutr. 115(2): 226–238.
Rahmani, J., C. Clark, H. K. Varkaneh, et al. 2019. “The Effect of Aronia Consumption on Lipid Profile, Blood Pressure, and Biomarkers of Inflammation: A Systematic Review and Meta-analysis of Randomized Controlled Trials.” Phytotherapy Res. 33(8): 1981–1990.
Reaver, A., S. Hewlings, K. Westerman, et al. 2019. “A Randomized, Placebo-Controlled, Double-Blind Crossover Study to Assess a Unique Phytosterol Ester Formulation in Lowering LDL Cholesterol Utilizing a Novel Virtual Tracking Tool.” Nutrients 11(9): 2108.
Roager, H. M., J. K. Vogt, M. Kristensen, et al. 2019. “Whole Grain-Rich Diet Reduces Body Weight and Systemic Low-grade Inflammation Without Inducing Major Changes of the Gut Microbiome: A Randomised Cross-over Trial.” Gut 68(1): 83–93.
Uddin, M., D. Biswas, A. Ghosh, et al. 2018. “Consumption of Fruitflow Lowers Blood Pressure in Pre-hypertensive Males: A Randomised, Placebo Controlled, Double Blind, Cross-over Study.” Int. J. Food Sci. Nutr. 69(4): 494–502.
Virani, S. S., A. Alonso, E. J. Benjamin, et al., and the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. 2020. “Heart Disease and Stroke Statistics-2020 Update: A Report from the American Heart Association.” Circulation 141(9): e1-e458. doi: 10.1161/CIR.0000000000000757.
Wolak, T., Y. Sharoni, J. Levy, et al. 2019. “Effect of Tomato Nutrient Complex on Blood Pressure: A Double Blind, Randomized Dose-Response Study.” Nutr. 11(5): 950.