Changes in nut consumption and subsequent cardiovascular disease risk among us men and women: 3 large prospective cohort studies

BACKGROUND: We aim to evaluate the association of within-individual changes in consumption of total and specific types of nuts and the subsequent risk of incident cardiovascular disease (CVD) in US men and women. METHODS AND RESULTS: We included 34 103 men from the HPFS (Health Professionals Follow-Up Study) (1986–2012), 77 815 women from the NHS (Nurses’ Health Study) (1986–2012), and 80 737 women from the NHS II (1991–2013). We assessed nut consumption every 4 years using validated food frequency questionnaires. We used multivariable Cox proportional hazards regression models to examine the association between 4-year changes in nut consumption and risk of confirmed CVD end points in the subsequent 4 years. Per 0.5 serving/day increase in total nut consumption was associated with lower risk of CVD (relative risk [RR], 0.92; 95% CI, 0.86–0.98), coronary heart disease (RR, 0.94; 95% CI, 0.89–0.99), and stroke (RR, 0.89; 95% CI, 0.83–0.95). Compared with individuals who remained nonconsumers in a 4-year interval, those who had higher consumption of total nuts (≥0.5 servings/day) had a lower risk of CVD (RR, 0.75; 95% CI, 0.67–0.84), coronary heart disease (RR, 0.80; 95% CI, 0.69–0.93), and stroke (RR, 0.68; 95% CI, 0.57–0.82) in next 4 years. Individuals who decreased nut consumption by ≥0.50 servings/day had a higher risk of developing CVD (RR, 1.14; 95% CI, 0.99–1.32), coronary heart disease (RR, 1.06; 95% CI, 0.88–1.28), and stroke (RR, 1.28; 95% CI, 1.02–1.60) when compared with those who maintained their nut consumption. CONCLUSIONS: Increasing total consumption of nuts and intake of individual types of nuts (eg, walnuts, other tree nuts, and peanuts) was associated with a subsequent lower risk of CVD. These data support the role of nut intake in the primary prevention of CVD.