Nut Consumption and Cardiovascular Disease Risk

Study Questions:

Is nut consumption inversely associated with cardiovascular disease (CVD) risk?


Data from the Nurses’ Health Study (NHS) (1980-2012), the Nurses’ Health Study II (NHS II) (1991-2013), and the Health Professionals Follow-up Study (HPS, follow-up) (1986-2012), all prospective cohort studies, were used for the present analysis. Participants were free of cancer, heart disease, and stroke at baseline. Food frequency questionnaires which assessed self-reported nut consumption were collected at baseline and every 4 years after that. Additional information on medical history, lifestyle, and health conditions were collected through self-administered questionnaires every 2 years.


The study population included 76,364 women from NHS, 92,946 women from NHS II, and 41,526 men from HPS (Follow-up study). Over 5,063,439 person-years of follow-up, a total of 14,136 incident CVD events were documented, including 8,390 coronary heart disease (CHD) events and 5,910 stroke events. Total nut consumption was inversely associated with total CVD and CHD after adjustment for CV risk factors. One serving of nuts (28 g) five or more times per week was associated with a 14% reduction in risk of cerebrovascular disease (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.79-0.93) compared to a reference group who reported never or almost never consuming nuts. A similar association was noted for CHD (HR, 0.80; 95% CI, 0.72-0.89; p trend < 0.001). Consumption of peanuts and tree nuts (two or more times/week) and walnuts (one or more times/week) was associated with a 13-19% lower risk of total CVD and 15-23% lower risk of CHD. Total nut consumption was not associated with reduced risk of stroke; however, peanut and walnut intake was associated with a risk reduction for stroke events.


The investigators concluded that in three large prospective cohort studies, higher consumption of total and specific types of nuts was inversely associated with total CVD and CHD.


These data suggest that a component of a healthy dietary pattern would include nuts, which are high in unsaturated fatty acids, dietary fiber, minerals, and vitamins. Providers may wish to include this recommendation in lifestyle counseling for patients. However, it should be noted that multiple servings per day of nuts could increase total caloric intake and thus increase risk for weight gain. The results here suggest one serving most days of the week is beneficial for CVD protection. As the authors note, further research would be needed to understand the mechanisms behind these associations.

Clinical Topics: Dyslipidemia, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Lipid Metabolism, Diet

Keywords: Cardiovascular Diseases, Cerebrovascular Disorders, Coronary Artery Disease, Diet, Energy Intake, Fatty Acids, Unsaturated, Nuts, Primary Prevention, Risk Factors, Risk Reduction Behavior, Stroke, Vascular Diseases

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