Heart disease is the leading cause of death in the U.S. Dietary supplements and lifestyle changes can help to support cardiovascular health.
There are several deadly diseases that plague the American population and cause severe illness, disability and death. None, however, are as common a heart disease, the leading cause of death in the U.S. According to www.healthline.com in an article titled “What are the 12 Leading Causes of Death in the United States?” heart disease accounts for 635,260 deaths per year, or 23.1 percent of total deaths. The article also pointed out that heart disease is more common among men, people who smoke, people who are overweight or obese, those with a family history of heart disease or heart attack and people over age 55.
Brian Keenan, ND, LaC, lead medical writer for Ayush Herbs located in Redmond, WA, noted that, according to the Centers for Disease Control and Prevention (CDC), “coronary heart disease is the most common type of heart disease, killing 350,900 people in 2019 and about 18.2 million adults aged 20 and older have coronary artery disease (CAD).” Furthermore, Dr. Keenan said, a heart attack occurs roughly every minute in the U.S.
“Every year, about 735,000 Americans have a heart attack. Of these, 525,000 are a first heart attack and 210,000 occur as a second heart attack,” added Hank Cheatham, vice president, Daiwa Health Development (Gardena, CA). “Heart failure has a prevalence of about 9 percent or 4.1 million Americans, with death occurring within five years from onset,” he continued.
Cheryl Myers, chief of scientific affairs and education, EuroMedica (Green Bay, WI), noted that “One of the most common cardiovascular issues is high blood pressure. With our inflammatory diet and sedentary lifestyles, it can be an astonishingly easy condition to develop. Of course, along with high blood pressure comes more damage to the arteries, a further spiral of inflammation and oxidative stress, and additional risk to oxidized LDL cholesterol, arterial blockage, stroke and many other conditions.”
Kristin Chapman, product manager and Dr. Vanessa Pavey, ND, education specialist at Life Extension located in Fort Lauderdale, FL, stated that “There are many contributing factors that can affect the health of the cardiovascular system. Some are not in our control, like age, genetics and family history; however, there are many factors that are controllable. The most well-documented lifestyle risk factors include obesity, sedentary lifestyle, cigarette smoking and nicotine, excessive alcohol consumption, poor diet and chronic stress.”
Céline Torres-Moon, science writer for Protocol for Life Balance (part of NOW Health Group) (Bloomingdale, IL), added that “Most of cardiovascular deaths are attributable to the following conditions: ischemic heart disease (IHD), stroke, hypertensive heart disease (which ultimately results in heart failure), cardiomyopathy and atrial fibrillation.”
Trends/State of the Market
According to Dr. Keenan, the cardiovascular support supplement market remains strong. “What is changing,” he noted, “is that people are becoming more proactive and are also looking for ‘natural’ support.” He added, “Blood pressure support is probably the biggest category under the cardiovascular umbrella. I think this is so because blood pressure concerns are common, and because it is something that consumers can monitor quite easily.”
Dr. Keenan also pointed out that “The trend of online shopping is probably the biggest force in growth of both cardiovascular supplements and the supplement industry in general. With the heavy use of social media, and the algorithmic approach to advertising, a person can simply search for ‘heart health tips’ and suddenly find themselves being offered supplements on every website they visit afterward.”
Cheatham noted that “The shift in food preferences and a sedentary lifestyle has boosted the prevalence of cardiovascular diseases in the U.S. … The growth of the global heart health supplements market can be attributed to the growing number of campaigns being held to spread awareness about the consumption of heart health supplements.” He added, “Furthermore, the contribution of regulatory authorities and government bodies toward increasing the consumption of heart health supplements is anticipated to drive the growth of the market over the forthcoming years.
Cheatham explained that other “Driving forces contributing to the growth of the heart health product category are the aging population attempting to maintain healthy heart function … and the overall awareness of the heart benefits that can be the result of a healthy lifestyle, healthy diet, exercise and use of nutraceutical or natural dietary supplements.”
COVID-19 has also impacted heart health, according to Cheatham. “Severe COVID-19 is associated with rapidly progressing systemic inflammation, a pro-inflammatory cytokine storm and sepsis, leading to multiorgan failure and death. Selected evidence and manifestations of CV (cardiovascular) injury in COVID-19 patients are available. Importantly, there is a delay between initiation of symptoms and myocardial damage in studies reported so far.”
Serena Goldstein, ND, located in San Francisco, CA stated that “many people also have metabolic syndrome (which includes not just heart disease, but also extra weight), live more sedentary lifestyles and while COVID-19 has had more deleterious symptoms than viruses in the past, many of the people who are affected tend to just not be healthy/have the healthiest terrain, and are more susceptible to said side effects or worse outcomes.”
According to Julia Craven, vice president of education and innovation at Enzyme Science located in Venice, FL, COVID-19 has had an impact on the market, as practicing preventative wellness has increased in popularity. “Many individuals are looking at what aspects of their lifestyle and overall health they can improve on. Given how common cardiovascular health issues have become and their possible correlation to the COVID-19 virus, many are practicing daily cardiovascular maintenance so that they can work to preserve their health.”
Chapman and Dr. Pavey pointed out that although the cardiovascular health category made up 5.6 percent of total supplement sales for 2020 and 2021, “early projections will see this category decline through 2023 (NBJ, 2021 Condition Specific Report).” She stressed, however, that “while the category numbers are not thrilling, this in no way diminishes the need for cardiovascular health supplements … opportunity still exists within the category to both capture the younger audience and help connect the whole-body health message to the consumer.”
Eric Anderson, senior vice president of marketing and Silvia Pisoni, global marketing manager, NattoPharma – Gnosis by Lesaffre (East Brunswick, NJ), stated that they have been “seeing the public gravitate toward more natural ingredients, such as those that are produced by microorganisms.” Like Craven, they noticed that consumers have been paying more attention to their overall health and wellness due to the pandemic.
Cardiovascular Health Supplements and Natural Treatment Approaches
Dr. Keenan offered three pieces of advice for those looking to preserve their heart health. “Exercise, move the body and sweat,” he began. “You need to use your cardiovascular system for it to remain flexible and dynamic, which prevents the stiffness of CAD.” Second, “Change the diet. While this can be a challenge to implement, there is simply no arguing with the data that supports removing all fried foods, processed foods and high sugar drinks and snacks, along with alcohol, from the diet and replacing it with leafy vegetables that are high in fiber.”
Lastly, Dr. Keenan stated that it is time that “the population at large makes a serious and concerted effort to remove stress wherever possible. It means going to therapy, practicing meditation, avoiding social media screens when used excessively, and, if applicable, working within one’s faith, and having clear and healthy work and rest boundaries. Yoga and Pranayama are famously useful here with good data to support them.”
As far as natural products that can be used to prevent heart health issues, Dr. Keenan stated that some supplements to keep in mind include omega-3 fish oil, such as Ayush Herbs’ High Omega-3 Fish Oil, as well as swapping out pure salt for a multi-mineral salt blend such as Wright Salt, also by the company. Furthermore, since stress plays a large role in heart health, Dr. Keenan recommended using ashwagandha for both healthy stress management and improving sleep and energy levels.
Ayush Herbs, according to Dr. Keenan, offers practitioners a supplement called Carditone, which “contains a suite of microminerals needed for cardiovascular homeostasis along with a host of ayurvedic herbs that have been used for heart health throughout millennia in India.” The company also offers a companion supplement called Arjuna Heart, which “is excellent for maintaining a healthy heart rate and rhythm of the heart and is loaded with antioxidants.” Dr. Keenan explained that one of the key ingredients in Carditone is “Rauwoflia serpentina, which has been studied repeatedly for supporting healthy blood pressure. We use whole plant extract of Rauwolfia, so it is not simply the tiny amount of the alkaloid reserpine contained within the plant that is doing the job.” Meanwhile, “Arjuna … has been studied for its ability to act as a potent antioxidant. Additionally, Arjuna, Terminalia chebula and Emblica officinalis are all high in gallic acid, which has been studied as a powerful antioxidant and useful in vascular support.”
Cheatham explained that some complementary and alternative approaches to promote heart health and treat cardiovascular issues include acupuncture, homeopathy, ayurveda, nutraceutical dietary supplements, chiropractic and mind-body treatments. Daiwa Health Development provides a number of cardiovascular health supplements to practitioners, including its Plasmanex1, which is “derived from soy, shown in clinical research to promote healthy blood circulation and to provide cardiovascular support. Bacillopeptidase F Proprietary Blend (BFPB), the active ingredient in Plasmanex1, [can] benefit many people and can be taken as either a preventative or as a therapy.”
Daiwa Health Development also provides Daiwa Krill Oil, “powered by Superba2 and Daiwa Krill Oil” and rich in omega-3s EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). Essential fatty acids (EFAs), according to Cheatham, have been shown to help manage healthy blood pressure and cholesterol levels, thereby promoting cardiovascular health.
Other supplements that can offer cardiovascular support include niacin and magnesium, Cheatham noted. “Recent studies suggest that niacin additionally improves the vascular endothelial cell redox state by inhibiting vascular inflammatory genes, oxidative stress and key cytokines that are involved in atherosclerosis (Ganji et al. 2009),” he explained. Additionally, “The multiple physiological and cardioprotective activities of magnesium include antiarrhythmic effects, calcium channel-blocking effects, improvement in NNO release from coronary endothelium and inhibition of blood coagulation (Shechter et al. 1999).”
Dr. Goldstein recommends several products and lifestyle changes to her patients to treat or prevent heart issues. She shared that many of her patients are always “on the go, putting others first, forcing themselves to work, or going against what they feel is right—and even if they wind up doing a lot of the ‘right’ things, there is a stress that comes along with going against the path of least resistance.” As a result, “To help with this, we talk about flower essences. I usually recommend hawthorn—which is not only a natural beta blocker to help reduce stress and increase sense of calmness, but also works on the emotional part of focusing where they can feel gratitude in their life.”
Some of Dr. Goldstein’s other favorite natural products to support cardiovascular health include “inositol, magnesium, optimal vitamin D levels, a methylated B complex, resveratrol/antioxidant support, and a blend of blood sugar support like gymnema, dandelion, fenugreek, ground flax seeds and a daily teaspoon of apple cider vinegar in some water as part of their daily routine.” She also recommends that her patients eat more greens and vegetables while including spices like garlic, fennel and onion to bring flavor to these foods, as well as benefits for cholesterol, blood sugar and gut health.
Craven advised that the best natural approach for cardiovascular health is lifestyle changes. She suggested incorporating more heart healthy foods into the diet, such as “berries, fish, spinach, garlic and extra-virgin olive oil.” Furthermore, “regular exercise, specifically aerobic exercise, can help to keep [the] heart strong. Minimizing stress, reducing alcohol intake and avoiding smoking can all help with not only cardiovascular health but overall wellness as well.”
Enzyme Science, according to Craven, focuses on gut health for total body wellness. “Enzymedica, Enzyme Science’s parent company, was the first to supply a Nattokinase formula with NSK-SD, the only form of Nattokinase Pro with three times the amount of this unique form of Nattokinase, making it one of the few products within the professional line to be using NSK-SD in an enzyme supplement for cardiovascular health.”* The product works to promote normal blood clotting, adequate blood flow and production of plasmin for optimal cardiovascular health.* What makes Nattokinase Pro so unique is “it contains the patented Nattokinase NSK-SD, which is processed in a unique way to remove vitamin K2, for those who should refrain from consuming that nutrient.”
Another product offered by Enzyme Science is Serrapeptase Pro, which “provides potent proteolytic enzymes to promote healthy circulation as well as support for cardiovascular and immune health.* Lastly, the company’s other cardiovascular health product is called Lypo Optimize, which “consists of potent lipase, amylase and protease made with exclusive Thera-blend technology to support healthy cardiovascular and circulatory systems when taken on an empty stomach.”*
Myers concurred with Dr. Goldstein and Craven, stating that “diet is always the place to start. Whole, anti-inflammatory fruits, vegetables and proteins are essential for health in general. Consistent exercise—a daily walk, swimming laps, bike rides three times a week—helps keep the heart strong.” EuroMedica offers a suite of cardiovascular health products that practitioners can give to their patients. These include EurOmega-3, which “provides omega-3s bound to phospholipids for better absorption and utilization by the body, plus the additional benefit of the phospholipids themselves and peptides.” The three-in-one supplement comes from salmon and delivers more than what fish oils alone are capable of, without the rancidity that turns patients away from compliance in a fish oil regimen.
EuroMedica’s A•D•K2 Cardio Health helps to build elasticity and strength in blood vessels and arterial walls. It provides a three-nutrient approach to cardiovascular health, delivering fat-soluble vitamins A, D3 and K2 for vascular health and reduction of deposition of calcium in blood vessels. The company’s Clinical OPC is a French grape seed extract VX1 which is tannin free and provides oligomeric proanthocyanidins (OPCs) that are standardized to be low molecular weight and 100 percent absorbable, unlike grape seed extracts with tannins, according to Myers. “OPCs reduce blood pressure, reduce the underlying inflammation and oxidative stress that trigger atherosclerotic changes and balance cholesterol and triglycerides.”
EuroMedica’s Healthy Cholesterol and Triglycerides product is a botanical supplement that features “a standardized extract of alma that has been the subject of five scientific studies [that] validate the potent effects of amla on cholesterol.” Its Berberine 500 mg and Berberine Ultra Absorption address factors related to metabolic syndrome, including cardiovascular concerns.
Lastly, EuroMedica’s CoQ10 100 mg is a chewable supplement enhanced with “GammaSorb (gamma cyclodextrin), which boosts absorption by eight times. It provides practitioners and patients with a convenient form of CoQ10 that is easily incorporated into a daily regimen.” As a result, more CoQ10 is being dispersed into the bloodstream, which provides benefits such as preventing blocked arteries, preventing recurrence of heart failure, controlling blood pressure and reducing damage caused by statins.
Annie Eng, CEO, HP Ingredients located in Bradenton, FL, mentioned one of the company’s signature ingredients for heart health: Bergamonte. “Bergamonte Bergamot Polyphenolic Fraction 100% (BPF), derived from Citrus Bergamia Risso from Italy’s Calabrian coast, improves overall biomarkers of hyperlipemia through reducing serum cholesterol, triglycerides, LDL and small dense lipoproteins, as well as increasing HDL. BPF also helps maintain normal serum glucose concentrations by supporting against insulin resistance.”
A study, according to Eng, showed that Bergamonte BPF “decreased the mean concentration of intermediate density lipoprotein (IDL) particles by 51 percent to increase large LDL by 38 percent, and to decrease small LDL by 35 percent. Moreover, 120-day treatment with BPF led to 20 percent increase of total HDL particles, mainly due to the increase of large HDL.”1
Lastly, “Bergamonte’s bruteridine and meltidine have been found to be able to inhibit HMGCoA reductase in a way similar to the one described for statins (statin-like mechanism). This effect occurs with no side effects. The vascular protection exhibited by BPF is caused by a powerful enhancement of nitric oxide-mediated vasodilatation. This occurs as a consequence of powerful inhibition of oxygen free radical species generation.”
Chapman and Dr. Pavey also explained the importance of exercise, diet, managing stress, ceasing to smoke, limiting alcohol consumption, monitoring blood pressure at home, lab testing and taking fish oil, CoQ10, vitamin D3, B vitamins, magnesium and other dietary supplements beneficial for heart health. They also emphasized the benefits of adopting a Mediterranean style diet, which “primarily focuses on vegetables, whole grains, nuts, legumes, fruits, omega-3 rich fatty acids and olive oil. It also limits processed foods, red meat, refined carbohydrates and sugary sweets.”
Life Extension, they continued, offers several cardiovascular health products. “We carry targeted herbal formulations for specific cardiovascular needs such as maintaining an already healthy blood pressure, lipid support and arterial health. We also have a range of CoQ10 and fish oil options to suit individual needs. Additionally, we provide magnesium, vitamin K2 and probiotics specifically targeted for cardiovascular health.”
The company’s Super Ubiquinol CoQ10 with PQQ is its best-in-class product for heart health, according to Chapman and Dr. Pavey. “It provides triple-action heart health support with three key nutrients that boost energy production at the cellular level. This includes a highly bioavailable form of CoQ10, known as ubiquinol, and is augmented with shilajit and PQQ to promote cardiovascular health and help promote youthful cellular energy production.” Life Extension also offers an Extended Release Magnesium, which is formulated with both oxide and citrate magnesium and is optimized “for both immediate and prolonged dissolution and uptake, a six-hour formula.”
Lastly, Life Extension’s FLORASSIST Heart Health probiotic supplement “is made with a novel probiotic, Lactobacillus reuteri 30242, shown to promote cardiovascular health by supporting already healthy cholesterol and C-reactive protein levels.” Chapman and Dr. Pavey added that there has been promising research on the benefits of vitamin K2 for cardiovascular health. Research published in the Journal of the American Heart Association, for instance, found that people with the highest intakes of vitamin K had lower risk of cardiovascular related disease. “Vitamin K helps inhibit calcification in the arteries and promotes healthy calcium absorption into the bones,” they concluded.
Anderson and Pisoni offered information on some of NattoPharma’s heart health supplements as well. “Quatrefolic from Gnosis by Lesaffre offers tangible advantages versus folic acid and can promote heart health. Reaching better blood levels of folate directly translates to lower homocysteine levels, especially for people with MTHFR polymorphism.” Additionally, they added, “calcification was once believed to be an irreversible process and a result of aging. However, it is now known that calcium accumulation is an actively regulated process involving the vitamin K-dependent Matrix Gla Protein (MGP), the most potent inhibitor of vascular calcification known, which is actively involved in recycling calcium. Healthy arterial tissues have shown to contain 100 times more vitamin K2 than unhealthy arteries, and the amount of calcium in the arteries is a risk factor for cardiovascular health.” Gnosis by Lesaffre offers two vitamin K2 ingredients, under the MenaQ7 and vitaMK7 brands.
Lastly, Torres-Moon offered information on some of Protocol for Life Balance’s cardiovascular health products. Their newest product, Clinical Cardio-6, “is a powerful combination of targeted nutrients and botanicals that are known to promote optimal cardiovascular health.* With L-carnitine and CoQ10 to support energy production in the heart, Hawthorn and MegaNatural-BP grape seed extract to support blood pressure already within the normal range, and MK-7 to help maintain arterial flexibility, Clinical Cardio-6 offers a comprehensive formula for healthy cardiovascular structures and functions.”*
Protocol for Life Balance also offers Cardio Tri-Plex containing red yeast rice, which “is carefully produced to avoid the presence of citrinin, an unwanted by-product of RYR fermentation process.” The product is further enhanced with CoQ10 and omega-3 fish oil to support healthy cardiovascular function.* The company also has CoQ10 in 100, 400 and 600 mg, all of which are pharmaceutical grade, all-trans form of CoQ10 produced by fermentation.
Its Garlic 5000 supplement is standardized to yield allicin and allicin precursors, which convert to allicin when ingested. The company also has 600 mg Hawthorn Extract, as the hawthorn plant, according to Torres-Moon, has been used to promote healthy cardiovascular function and scientific research has provided evidence of its cardiac-supporting properties.* Like Enzyme Science, Protocol for Life Balance also offers a Nattokinase product.
The company’s Proto-Sitosterol Plant Sterol Esters contains CardioAid-S Plant Sterol Esters, “a unique dietary supplement ingredient with the ester forms of the plant sterols beta-sitosterol, campesterol and stimasterol. They have been found to compete with cholesterol in the digestive tract, thereby limiting its absorption.”* Other products that the company offers include Red Yeast Rice Extract, 600 mg, Red Yeast Rice Plus, D-Ribose and Ubiquinol, 100 or 200 mg.
Like Life Extension and NattoPharma, Protocol for Life Balance recognizes the important of vitamin K2 for heart health. Torres-Moon pointed out that “it is a vitamin that is not well represented in a typical American diet, and there is no official recommended daily value and no routine laboratory test to evaluate deficiency; therefore, some practitioners might not always think about it when evaluating the supplementation needs of patients wishing to bolster cardiovascular health.* This vitamin should probably be a cornerstone of most supplementation protocols when promoting cardiovascular health.”* As a result, Protocol for Life Balance also offers MK-7 Vitamin K2 160 mcg & 300 mcg.
Advice for Practitioners
“The best thing a doctor … can do is to promote healthy lifestyle behaviors starting with diet and exercise,” said Dr. Keenan. “Work closely with each unique patient to understand the barriers that they may have to implementing changes. Additionally, doctors need to be asking about mental health and going a step further to ask about mental health/stress reducing practices.” He continued, “Mindfulness and meditation are golden keys to the overall health puzzle, and the savvy clinician [recommends] these and offering guidance where needed.”
Dr. Goldstein advised that practitioners should question patients about their mental and emotional health. She elaborated, “The heart chakra … helps connect the physical centers below to the spiritual centers above and makes sense of the world in ways our mind can’t yet comprehend. Ask them what they desire—in health, their life and at the very least, what they can begin to think about—as even thinking about something means some sort of energy shift is taking place.”
According to Craven, “Health care professionals can encourage their patients to maintain healthy lifestyle choices that serve as preventative measures and minimize the risk of cardiovascular issues. By encouraging patients to eat healthy, exercise and find coping mechanisms for stress, practitioners can help their patients find comfort, knowing they can take control of their cardiovascular wellness.”
Myers stated that she thinks “practitioners can simply keep doing what they are best at: listening to their patients and treating the whole person, not just the symptoms or conditions. Discovering where the right interventions fit into a patients’ life and the steps that they can (and are willing) to take to stay healthy are critical. And just being there as a trusted professional and helpful coach can work wonders.”
Anderson and Pisoni advised practitioners to help explain to their patients that some factors are not controllable, like age, genetics and family history; however, there are many lifestyle factors that are in the patient’s control.” They continued, “Practitioners can assist in providing guidance in starting an exercise program, incorporating a Mediterranean style diet, stress management, smoking cessation, education on alcohol consumption, teaching how to monitor blood pressure at home and running comprehensive lab testing … [as well as] suggesting science-based foundational nutrients that provide daily cardiovascular support.”
All in all, practitioners should keep diet, physical activity and clinically studied dietary supplements in mind when it comes to advising their patients on how to best take control of their cardiovascular health.
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
1 Mollace, V., et al. “Hypolipemic and hypoglycaemic activity of bergamot polyphenols: From animal models to human studies.” Fitoterapia 82 (2011) 309-316.
Healthy Take Aways
• Heart disease accounts for 635,260 deaths per year, or 23.1 percent of total deaths.
• Every year, about 735,000 Americans have a heart attack. Of these, 525,000 are a first heart attack and 210,000 occur as a second heart attack.
• Coronary heart disease is the most common type of heart disease, killing 350,900 people in 2019.
• About 18.2 million adults aged 20 and older have coronary artery disease (CAD).
For More Information:
Ayush Herbs, www.ayush.com
Daiwa Health Development, www.dhdusa.net
Enzyme Science, www.enzyscience.com
HP Ingredients, www.hpingredients.com
Life Extension, www.lifeextension.com
Protocol for Life Balance (NOW Foods), www.protocolforlife.com