Updated: Oct 23, 2021
Heart disease is the leading cause of mortality among Americans crossing both sexes and most racial and ethnic groups.
According to the American Heart Association (AHA), in conjunction with the National Institutes of Health (NIH), annual reports concerning the leading causes of deaths for Americans is heart disease; and rising from year to year, making it the leading cause of death in the United States. 
Dietary-related modifications are growing among Americans seeking dietary modifications coupled with pharmacological and interventional care to assist with the fight against heart disease. One such food product that has grown in popularity, to potentially combat heart disease, is the vegetable, beets. Therefore, we will explore the many benefits of beet consumption on heart health.
Beets or properly beetroot is the taproot part of the beet plant. It is the main root that develops into a vegetable with small roots sprouting out. A beetroot is categorized as beta vulgaris and belongs to a flowering plant subfamily called Amaranth belonging to the Caryophyllales plant family. Amaranth plants are flowering plants that consist of 175 genera and more than 2,500 species. The family of plants consists of herbs, subshrubs, and even some succulents. 
The distinct red or yellow color of beets comes from a pigment called betalain. There are four major classes of plant pigments; which include, Chlorophyll, Carotenoids, Flavonoids/Anthocyanins, and Betalains.  Betalain is an antioxidant compound and a pigment contained in plant vacuoles of the Caryophyllales plant family. They are known as dietary cationized antioxidants, meaning they are Hydrogen electron donors. Due to their color, they were thought to be like, the plant pigment Anthocyanins.
Anthocyanins have been heavily studied for their antioxidant and modulating free radical capabilities which are similar characteristics that Betalain share. The difference is betalain is only found in water-soluble nitrogen-containing vacuolar pigments and replaces the anthocyanins in flowers and fruits of most families of the Caryophyllales.  Betalains' capabilities to replace anthocyanins in certain plants and fruits differentiate them from Anthocyanins. Betalains also differ from Anthocyanins because they contain nitrogen. An important point when discussing the importance of beets on heart health.
Betalains are used as additives in foods, are highly soluble, and are absent of toxins . Therefore, the study of these capabilities contained in beets has grown since being highlighted. Due to the availability of Betalains contained in beets. Those anti-radical and antioxidative activities are being studied to help assist with heart health.
Researchers found that betalain exhibits significant free radical scavenging activity, which contributes to stabilizing free radicals that lead to oxidative stress and eventually cell apoptosis, which leads to chronic inflammation. Chronic inflammation is known to be a culprit and exasperates the effects of atherosclerosis which further contributes to heart disease.
Besides betalain, beets also contain potent phenolic compounds and high levels of inorganic nitrate content. The inorganic nitrate contained in beets modulates nitric oxide that assists in several metabolic and vascular functions, most notably, blood vessel function by improving endothelial function. Thus, beets can exhibit an anti-hypertensive effect.
As researchers have stated, “Recent studies have provided compelling evidence that beetroot ingestion offers beneficial physiological effects that may translate to improved clinical outcomes for several pathologies, such as; hypertension, atherosclerosis, type 2 diabetes, and dementia". 
Hypertension has been a particular target of many therapeutic interventions and there are numerous studies that show beetroot, delivered acutely as a juice supplement or in baked goods like bread, etc. significantly reduce systolic and diastolic blood pressure. 
The combination of betalains, antioxidative capabilities, along with inorganic nitrate effects on blood vessel function, and blood flow; in conjunction, with potent phenolic compounds, along with ascorbic acid, and carotenoids, contained in beets shows its significant power as a nutritive intervention.
Therefore, beet supplementation and consumption have strong potential to be used as a nutritive intervention to address associated illnesses such as atherosclerosis and hypertension that eventually lead to heart disease.
The potential for beet consumption and supplementation on clinical pathologies is worth investigating. As the leading cause of death in America, for several years running, and on the rise, we can no longer ignore the importance of nutritive intervention along with other interventions in the fight against heart disease.
Beets' ability to improve blood flow and attenuate oxidative stress before it causes chronic inflammation gives it the potential to intervene in the progression of heart disease, by improving heart and cardiovascular health.
References:  Encyclopedia Britannica (2016, January 19). Encyclopedia Britannica: Amaranthaceae. Retrieved from https://www.britannica.com/plant/Amaranthaceae.  Clifford et al. (2015). The Potential Benefits of Red Beetroot Supplementation in Health and Disease. Journal: Nutrients, 7, 2801-2822.  Koubaier et al. (2014). Betalain and Phenolic Compositions, Antioxidant Activity of Tunisian Red Beet (Beta vulgaris L. conditiva) Roots and Stems Extracts. International Journal of Food Properties, 17 (9), 1934-1945.  Nakatsuka et al. (2013). Genetic engineering of yellow betalain pigments beyond the species barrier. Nature: Scientific Reports, 3, 1-7.  Siervo et al. (2013). Inorganic Nitrate and Beetroot Juice Supplementation Reduces Blood Pressure in Adults: A Systematic Review and Meta-Analysis. Journal of Nutrition, 143
(6), 818–826.  Tanaka et al. (2008). Biosynthesis of plant pigments: anthocyanins, betalains and carotenoids. The Plant Journal, 54, 733-749.
 Virani et al. (2020). Heart Disease and Stroke Statistics-2020 Update. American Heart Association: Circulation, 141 (28), e1-e458.