According to World Health Organisation (WHO) figures, 12% of men and 5% of women in Europe die from cardiovascular disease (CVD) before the age of 65.Such statistics might make grim reading for consumers, but for food manufacturers they signal a market with great potential.
That's certainly the view of Shirley Horn, senior director, global marketing and communications, with the Almond Board of California, who predicts a bright future for heart healthy products.
"The European market - and indeed the global food market - will continue to grow in the area of heart health. This is driven by consumer demand, societal pressures and governmental concerns over rising rates of cardiovascular disease, obesity, diabetes and other lifestyle diseases, and the parallel rising costs of providing healthcare."
Sustainable opportunity?
There's no doubt that food manufacturers agree there's an opportunity. Mintel's Global New Products Database recorded 1,309 functional food launches last year, of which 698 carried a heart health claim.
But whether these products have the staying power to become a regular item on shopping lists is less certain. Unilever's blood pressure-reducing Flora pro.activ mini drink containing dairy peptides and Danone's omega-3 and sterol-fortified drink Danacol were withdrawn from the market, leaving in their wake much scepticism about the real potential of the heart healthy products market.
But it seems brand owners are not ready to admit defeat. Unilever has introduced Promise Supershots for blood pressure control in the US and Danone has launched a blood pressure control drink in Spain under the Danaten brand.
Interestingly, both products are being marketed on a blood pressure management platform: a claim area that has historically only accounted for a tiny proportion of heart health product launches.
"The blood pressure control market has been developing at a rather modest pace," says DSM's Luc van der Heyden, business manager heart health. "We believe this is due to several factors limiting its growth: taste, cost in use, patents and difficulties getting ingredients into specific applications such as tablets and drinks."
DSM claims its new TensGuard dairy peptide ingredient, which helps control blood pressure, represents a breakthrough in this field. The first dietary supplements containing TensGuard have just been launched and the first food products are due to debut this autumn.
Strength of the brand
"With the cholesterol market now starting to mature, this is an excellent opportunity for food and beverage manufacturers to strengthen their heart health brands. New product extensions are targeting blood pressure management as well as heart health," says van der Heyden.
DKSH is another ingredient supplier that is active in dairy peptides, and Kavan Ranasinghe, business line manager, food & ingredients, thinks it offers much potential.
"Dairy peptide technology is still quite new," he says. "It originated in Japan and there are only a handful of products on the European market containing dairy peptides. These include Works with Water's 120/80 and Emmi's Evolus."
Another ingredient that boasts a growing body of evidence in blood pressure management is soy protein, according to Solae's marketing communications manager Floriane Jacquemet. However, she concedes that the most robust science for soy protein is in cholesterol lowering.
"Claims related to cholesterol lowering are currently the strongest, and because of the close relationship of this biomarker to heart disease, data is likely to get stronger."
The cholesterol lowering market might be more mature than the blood pressure management one, but there's still life in it.
The right ingredients
Viscofiber from Natraceutical Group is a soluble fibre ingredient with a high concentration of beta-glucan which can help maintain cholesterol levels that are already within the normal range.
While there are already a number of products on the European market containing beta-glucan, Kristina Williams, VP marketing and sales with Natraceutical, believes there is untapped potential in products that have traditionally been prevented from making cholesterol claims due to volume restrictions.
"Take oat bran," she says, "you need so much of it to reach an effective level that it isn't possible to use it to make a claim in, say, single-serve yoghurts or nutritional bars, as you can't get the volume in there. Because Viscofiber is a concentrate you only need a small volume to achieve the effective amount of beta-glucan."
Another opportunity could exist in ingredients that are familiar to consumers for their benefits in other health areas.
Omega-3, for example, has established credibility for its brain health credentials. Cassie France-Kelly is public relations manager with Martek, manufacturer of life'sDHA - a vegetarian form of omega-3 derived from microalgae. She says: "Some of the strongest evidence for DHA relates to brain health, but emerging evidence supports the role of DHA in heart health."
She estimates there are about 100 products on the US market containing Martek's DHA, most of which sport a brain health claim, and some of which also carry a heart health claim. However, only a few carry a heart claim without a brain health claim.
"I think one of the reasons why firms have gone with a brain health rather than a heart positioning is because it's a less 'cluttered' area; there are a lot of things consumers can do to improve heart health, but eating more DHA is one of the few things people can to do to improve brain health. However, we may see this changing as the evidence for heart health grows."
One barrier to development could be that people don't want to think about heart disease, she says. "Research shows it's one of the biggest worries people have, but unfortunately, heart health is something a lot of people don't want to think about."
An even bigger obstacle is the EU Nutrition and Health Claims Regulation. "Right now, everyone is waiting to see what the European Food Safety Authority (EFSA) will say, which is posing a bit of a challenge," says Natraceutical's Williams. "It will be 2010 before we know what claims will be permitted. In the meantime, manufacturers can make claims under national regulations, but the question is whether they will change in 2010."
Most ingredient manufacturers who have filed for claims seem to be confident that they will be approved by EFSA.
"I can't judge what kind of science EFSA will require, but if you look at heart healthy ingredients, beta-glucans have a long history and solid science," says Williams.
Martek's France-Kelly says: "The evidence for omega-3 and DHA is very strong so we have no reason to believe there won't be an approval under Article 13."
But no-one is taking anything for granted. "From the first evaluations of EFSA it appears a rigidly scientific approach is being taken and only a few claims will survive EFSA's scrutiny. In general it is expected that fewer claims will be available unless there is general scientific consensus supported by the totality of evidence," says Solae's Jacquemet.
Manufacturers might not have much control over regulation, but they can respond to consumer communication.
"A food product is never going to be a drug," says DKSH's Ranasinghe. "Dairy peptides have a mild effect. The challenge is communicating that: if it's too scientific it's a turn-off; if it's not scientific enough it's considered woolly."
Persuasive communication is something manufacturers have mastered in the digestive health arena. If they can work out how to push the right buttons for consumers concerned about CVD, they should be able to beat the cynics as well.
Rising stars
Seaweed and cocoa could usurp sterols in heart healthy products, as new science emerges.
A clinical study involving 60 participants is currently underway for Diana Natural's fucus extract ingredient HealSea.
HealSea has been proven to reduce the development of atherosclerosis in animals and is a powerful antioxidant that can help promote cardiovascular health, according to Diana Naturals. The study is being carried out in partnership with SETALG and supported by Valorial, and Diana Naturals says the results should enable it to apply for a cardiovascular health claim under Article 13 or 14.
Cocoa polyphenols have also been linked to a reduced risk of CVD. According to Natraceutical, which manufactures cocoa polyphenols under its CocoanOX (CCX) brand, they inhibit the oxidation of cholesterol, which prevents it being deposited in the arteries of the heart.
The firm's Zachary Sniderman points out that the claims currently permitted for CCX are limited to content claims. However, he says the publication of scientific studies is increasing knowledge and many producers are finding that just declaring the amount within is enough.
"With the current advancement of research into cocoa polyphenols, I think we are going to see more products utilising them for their healthy properties," he says.