Is dietary almonds effective in increasing serum HDL cholesterol among coronary artery disease (CAD) patients?
Date of publication of the randomized controlled trial: October 2015
Design
Randomized controlled trial (RCT).
Participants
150 CAD patients with optimal LDL cholesterol (<100mg/dL) and low HDL cholesterol (men< 40mg/dL and women <50mg/dL) (age range: 32 to 86 years, male%: 75.3%).
Intervention
The Pakistani or American almonds were dispensed in the form of pre-weighed packets (10g per day) for 6 weeks. Participants were instructed to soak the almonds overnight and eat them after removing the skin, before breakfast (presumably on an empty stomach).
Comparator
Comparison 1: Pakistani almonds versus no intervention. No intervention referred to no almonds consumption, and participants were instructed not to consume other nuts during their enrollment in the trial.
Comparison 2: American almonds versus no intervention.
Major Outcomes
Outcome 1: Serum concentrations of HDL cholesterol as measured using a c-111 automated analyzer at week 6.
Settings
This study was performed in an outpatient setting.
Comparison    Pakistani almonds versus no intervention
Main Results
Compared to no intervention, Pakistani almonds led to a significant increase in serum HDL cholesterol concentrations among CAD patients by 11%.
Comparison: Pakistani almonds versus no intervention in CAD patients
Outcomes No. of studies (Total number of participants) Mean value/No. of participants Heterogeneity test (I2) Percentage change (95% CI) Overall quality of evidence*
Intervention Comparator
1 1 (72) 38.5/38 34.6/34 Not applicable as there is only 1 study. 11% (not reported) Moderate
Keys: CI = confidence interval.
Comparison    American almonds versus no intervention
Main Results
Compared to no intervention, American almonds led to a significant increase in serum HDL cholesterol concentrations among CAD patients by 9%.
Comparison: American almonds versus no intervention in CAD patients
Outcomes No. of studies (Total number of participants) Mean value/No. of participants Heterogeneity test ( I2) Percentage change (95% CI) Overall quality of evidence*
Intervention Comparator
1 1 (75) 37.6/41 34.6/34 Not applicable as there is only 1 study. 9% (not reported) Moderate
Keys: CI = confidence interval.
Comparison    Pakistani almonds versus no intervention
Main Results
Compared to no intervention, Pakistani almonds led to a significant increase in serum HDL cholesterol concentrations among CAD patients by 11%.
Comparison: Pakistani almonds versus no intervention in CAD patients
Outcomes 1
No. of studies (Total number of participants) 1 (72)
Mean value/No. of participants Intervention 38.5/38
Comparator 34.6/34
Percentage change (95% CI) 11% (not reported)
Overall quality of evidence* Moderate
Keys: CI = confidence interval.
Comparison    American almonds versus no intervention
Main Results
Compared to no intervention, American almonds led to a significant increase in serum HDL cholesterol concentrations among CAD patients by 9%.
Comparison: American almonds versus no intervention in CAD patients
Outcomes 1
No. of studies (Total number of participants) 1 (75)
Mean value/No. of participants Intervention 37.6/41
Comparator 34.6/34
Percentage change (95% CI) 9% (not reported)
Overall quality of evidence* Moderate
Keys: CI = confidence interval.
Conclusion
Benefits
Compared to no intervention, a low dose of Pakistan or American almonds (10g per day) consumed before breakfast can increase HDL cholesterol among patients with CAD. For all outcomes, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
Harms
The authors did not report details of adverse events.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/26269239
The synopsis is based on the following article:
Jamshed H., Sultan F.A., Iqbal R., Gilani A.H.. Dietary Almonds Increase Serum HDL Cholesterol in Coronary Artery Disease Patients in a Randomized Controlled Trial. J Nutr. 2015 Oct;145(10):2287-92.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.