Nut Consumption and Risk of Cardiovascular Disease and Ischemic Heart Disease Mortality: The Adventist Health Study 2

Cardiovascular disease (CVD) and ischemic heart disease (IHD) are leading causes of mortality worldwide. Nut consumption has been associated with reduced risk.

To examine the associations between total nut and tree nut intake with CVD and IHD mortality, and to explore the potential benefits of substituting nuts for less heart-healthy foods.

This prospective cohort study followed 80,529 Adventist participants for an average of 11.1 y. During this period, 4258 CVD deaths, including 1529 IHD deaths, were recorded. Dietary intake was assessed using a validated food frequency questionnaire. We examined total nut intake (combining tree nuts, peanuts, and peanut butter) as well as tree nut intake specifically (including almonds, cashews, walnuts, and mixed nuts). Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for demographic, dietary, and lifestyle factors.

Participants with higher nut intake tended to be older, more educated, and reported healthier lifestyle behaviors. After multivariable adjustment, higher total nut intake was significantly associated with lower CVD (HR: 0.86; 95% CI: 0.79, 0.94) and IHD mortality (HR: 0.81; 95% CI: 0.70, 0.94) when comparing the 90th with the 10th percentile of intake. Stronger inverse associations were observed with tree nut intake and CVD (HR: 0.83; 95% CI: 0.74, 0.92) and IHD mortality (HR: 0.73; 95% CI: 0.62, 0.87). Substitution analysis revealed that replacing unprocessed red meats and processed meats with total nuts and tree nuts was associated with lower risk of CVD and IHD mortality.

Higher intakes of total nuts and tree nuts are associated with significantly lower risk of CVD and IHD mortality. These findings support dietary recommendations to increase nut consumption as part of a heart-healthy diet.