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Christine M. Albert, MD, MPH; J. Michael Gaziano, MD, MPH; Walter C. Willett, MD, DrPH; JoAnn E. Manson, MD, DrPH

Arch Intern Med. 2002;162:1382-1387.

Background  Dietary nut intake has been associated with a reduced risk of coronary heart disease mortality; however, the mechanism is unclear. Since components of nuts may have antiarrhythmic properties, part of the benefit may be due to a reduction in sudden cardiac death.

Methods  We prospectively assessed whether increasing frequency of nut consumption, as ascertained by an abbreviated food frequency questionnaire at 12 months of follow-up, was associated with a lower risk of sudden cardiac death and other coronary heart disease end points among 21 454 male participants enrolled in the US Physicians' Health Study. Participants were followed up for an average of 17 years.

Results  Dietary nut intake was associated with a significantly reduced risk of sudden cardiac death after controlling for known cardiac risk factors and other dietary habits (P for trend, .01). Compared with men who rarely or never consumed nuts, those who consumed nuts 2 or more times per week had reduced risks of sudden cardiac death (relative risk, 0.53; 95% confidence interval, 0.30-0.92) and total coronary heart disease death (relative risk, 0.70; 95% confidence interval, 0.50-0.98). In contrast, nut intake was not associated with significantly reduced risks of nonsudden coronary heart disease death or nonfatal myocardial infarction.

Conclusion  These prospective data in US male physicians suggest that the inverse association between nut consumption and total coronary heart disease death is primarily due to a reduction in the risk of sudden cardiac death.

From the Division of Preventive Medicine (Drs Albert, Gaziano, Manson), Channing Laboratory (Drs Willett and Manson), and Cardiovascular Medicine (Dr Gaziano), Department of Medicine, Brigham and Women's Hospital; Cardiovascular Division, Department of Medicine, Massachusetts General Hospital (Dr Albert); and Departments of Epidemiology (Drs Willett and Manson) and Nutrition (Dr Willett), Harvard School of Public Health, Boston, Mass.

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