Almond Consumption on HDL Cholesterol and CVD Risk Factors in Adults with High Cholesterol: A Randomized, Comparator-Controlled Trial

Dietary modifications are recommended for individuals with hypercholesterolemia to reduce cardiovascular disease (CVD) risk. While almonds have been shown to improve certain CVD risk factors, the effects of almonds on high-density lipoprotein cholesterol (HDL-C) are less clear. This study aimed to determine the quantity of almonds that would provide optimal increases in HDL-C in a population with hypercholesterolemia. Participants were randomized (<i>n</i> = 25/group) to low-dose almond (LDA; 1.5 oz/day), high-dose almond (HDA; 2.5 oz/day), or nut-free diet (NFD; cookies isocaloric to LDA) for 16 weeks. Change in HDL-C (primary outcome), Framingham Risk Score (FRS), blood pressure (BP), apolipoproteins, anthropometrics, and serum α-tocopherol were assessed at baseline and weeks 4, 8, 12, and 16. There were no significant differences in HDL-C between groups; however, there were reductions in FRS of 1.4% and 0.6% from baseline at week 16 in the HDA and LDA groups (<i>P</i> ≤ .05), respectively, while the NFD group had a 1.0% decrease (<i>P</i> = .14). There were decreases of 4.7 mmHg, 4.1 mmHg, 5.1 mmHg, and 3.8 mmHg in systolic BP for the HDA group after 4, 8, 12, and 16 weeks, respectively (<i>P</i> ≤ .06), which was significantly lower than the NFD group from baseline at week 8. The NFD group had increases in sagittal abdominal diameter of 4.0% and 2.7% after 4 and 8 weeks (<i>P</i> ≤ .05), respectively, whereas the almond groups did not. Findings suggest almond consumption may support dietary strategies for improving CVD risk factors in adults with hypercholesterolemia.