A major new review has confirmed that eating almonds can significantly improve a range of blood lipid markers – particularly in people with elevated LDL (bad) cholesterol levels (1).

The research also found eating almonds improved the ratio of Apo B:ApoA – a key marker of heart health not previously investigated in earlier reviews.

The systematic review and meta-analysis, of 36 scientific papers, was recently published in the journal Nutrients.

About the study

The review collated the results of earlier clinical trials, involving a total of 2,485 adults.

Study participants were generally healthy or had cardiovascular risk factors (such as type 2 diabetes or overweight/obesity), but did not have cardiovascular disease (CVD).

Almond intake across the trials ranged from 25 to 168g per day, with study periods lasting from 4 to 72 weeks.

Did you know? A daily handful of nuts can reduce the risk of developing CVD by 21% and coronary heart disease by 25% (2). And for people with heart disease, eating nuts can reduce the risk of dying from it.

The key findings

Compared with the control group (those who didn’t eat almonds), almond consumption led to significant reductions in:

• LDL (bad) cholesterol
• Total cholesterol (TC)
• Non-HDL cholesterol
• Apolipoprotein B (Apo B)

Eating almonds also improved key cholesterol ratios, shifting them toward a more protective profile:

• TC:HDL cholesterol
• LDL:HDL (bad:good) cholesterol
• Apo B:Apo A

Almonds did not affect HDL (good) cholesterol, Apo A, or Lipoprotein(a) levels, and they showed a borderline significant reduction in triglycerides.

Did you know? In just one year, at least $281 million could be saved in health care expenditure due to CVD if every Australian were to eat 30g of nuts daily (3). 

Apolipoproteins: A lesser-known predictor of CVD risk

Beyond traditional cholesterol measures (such as total cholesterol, LDL cholesterol, HDL cholesterol, and their ratios), apolipoproteins – which carry lipids in the blood – are now recognised as important markers of heart disease risk.

Apo A is often referred to as ‘good cholesterol’ because it helps remove excess cholesterol from the arteries and supports endothelial health. In contrast, Apo B is regarded as a ‘bad cholesterol’ as it carries atherogenic lipoproteins – like LDL cholesterol – into arterial plaques.

In this review, almond consumption did not significantly alter beneficial Apo A levels, but it did lead to a meaningful reduction in harmful Apo B. This, in turn, improved the Apo B:Apo A ratio.

This suggests that one way that almonds offer cardioprotective benefits is by reducing the transport of cholesterol into arterial plaques.

Almonds provide phytosterols that help block cholesterol absorption, healthy fats (especially oleic and linoleic acids) that improve blood lipid profiles, and vitamin E, which protects lipids from oxidative damage. They also support weight management, which can benefit blood lipid levels.

Heart-healthy ways with almonds

• Breakfast: Top cereal or yoghurt with almonds, blend into smoothies, or make a ‘nutty’ muesli, with almonds as an ingredient.
• Lunch and dinner: Toss almonds into salads and frittatas, or use as a crumb for schnitzel or fish.
• Snacks: A handful of nuts (such as almonds) is the easiest nut snack! Other ideas are protein bliss balls, almond-topped yoghurt, or almond butter with apple or veggie sticks.
• Cooking: Swap regular flour for almond meal in baking, or blend almonds into homemade dips.

The bottom line:

Eating almonds can improve a range of blood lipid levels, especially in people with elevated LDL cholesterol. And the positive effect of almonds on the Apo B:Apo A ratio is highly encouraging. The findings help explain why a regular intake of nuts (almonds, in this case!), as part of a heart healthy eating pattern, reduces the risk of CVD.