Building a better cardio product

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. We are interested in maintaining a healthy cardiovascular system not least because it is the top reason we die — more than one of every three of us die from heart disease.

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

Nutrients can help address all of these symptoms. Whether you are thinking of launching a new product in this area — or refurbishing an old one by adding that 'new and improved' ingredient — there is much science to validate the nutritional approach. This fact has not been lost on marketers — 134 new food and beverage products targeting cardiovascular health were launched in the United States between January 1 and September 23 of 2008, according to Mintel's Global New Products Database.

The easy target is cholesterol levels, in particular keeping LDL cholesterol levels low (keeping HDL levels high is another good target, though more elusive to remedy). Doctors routinely counsel patients to keep cholesterol levels below 200mg/dL.

The inconvenient truth is that about an equal number of people die from cardio events with cholesterol below 200 as above. A Harvard physician, in a 2007 Lancet paper titled 'Are Lipid-Lowering Guidelines Evidence-Based?' described how no studies have shown statin cholesterol-lowering drugs to be effective for women at any age, nor for men 69 years of age or older, who do not already have heart disease or diabetes.¹ Indeed, studies show between 45 and 60 per cent of patients hospitalised for a heart attack have a 'normal level' of cholesterol.^2,3

So, if cholesterol won't necessarily give you a heart attack, what will? A 2007 study at the Cooper Clinic in Texas suggests the answer may be calcium. After controlling for age, gender, blood lipids, diabetes, tobacco use, hypertension and family history of premature heart disease among 303 patients, those with a coronary artery calcium score of less than 10 had only 1.7 per cent likelihood of having ischemia, or decreased arterial blood flow. For those with higher levels of calcium, the likelihood was 20 per cent — a greater than ten-fold difference.⁴

Some studies show that coronary calcium content is a good predictor of future coronary events in both symptomatic and asymptomatic populations.^5,6,7 These studies indicate that abundant mature coronary plaque is at least a risk factor for clinical events and, possibly, is a cause of those events. But other studies show that some patients with acute coronary syndromes have little or no coronary calcium.^8,9,10

So, controversy remains about whether calcium in plaque is a marker of stability or instability. When plaque is unstable, it is thought to lead to heart attack and stroke, respectively.