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3 Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802; 4 Department of Nutrition, Harvard School of Public Health and Channing Laboratory, Brigham and Women's Hospital, Boston, MA 02115; 5 Unitat de Lípids, Sevei d'Endocrinologia i Nutrició, Institut d'Investigacions Biomèdiques August Pi Sunyer, Hospital Clínic, Barcelona, 08036 Barcelona, Spain; and Ciber CB06/03 Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III, Spain; and 6 Department of Nutrition, Loma Linda University, Loma Linda, CA 92350
Epidemiologic and clinical trial evidence has demonstrated consistent benefits of nut and peanut consumption on coronary heart disease (CHD) risk and associated risk factors. The epidemiologic studies have reported various endpoints, including fatal CHD, total CHD death, total CHD, and nonfatal myocardial infarct. A pooled analysis of 4 U.S. epidemiologic studies showed that subjects in the highest intake group for nut consumption had an 
35% reduced risk of CHD incidence. The reduction in total CHD death was due primarily to a decrease in sudden cardiac death. Clinical studies have evaluated the effects of many different nuts and peanuts on lipids, lipoproteins, and various CHD risk factors, including oxidation, inflammation, and vascular reactivity. Evidence from these studies consistently shows a beneficial effect on these CHD risk factors. The LDL cholesterol-lowering response of nut and peanut studies is greater than expected on the basis of blood cholesterol-lowering equations that are derived from changes in the fatty acid profile of the diet. Thus, in addition to a favorable fatty acid profile, nuts and peanuts contain other bioactive compounds that explain their multiple cardiovascular benefits. Other macronutrients include plant protein and fiber; micronutrients including potassium, calcium, magnesium, and tocopherols; and phytochemicals such as phytosterols, phenolic compounds, resveratrol, and arginine. Nuts and peanuts are food sources that are a composite of numerous cardioprotective nutrients and if routinely incorporated in a healthy diet, population risk of CHD would therefore be expected to decrease markedly.
* To whom correspondence should be addressed. E-mail: pmk3{at}psu.edu.
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