New modeling research using change in LDL-cholesterol levels as marker for cardiovascular disease risk shows eating 42.5g of almonds each day can make a difference
Recent research by Tufts University shows that eating 42.5 grams of almonds each day compared to not eating almonds may help reduce healthcare costs associated with cardiovascular disease among US consumers.1 The study was funded by the Almond Board of California.
According to the World Health Organization, Cardiovascular diseases (CVD) is the number one cause of deaths across the globe, and in India2. CVD is also a costly disease to treat and can cause a huge economic burden on the patient, and his/her family. For India in particular, CVD has become a severe cause of concern, owing to the disease’s accelerated buildup, early age of onset in the population and the high case fatality rate3. Some factors that have contributed to the rise of CVD cases across India include the south Asian genetic makeup and it’s proneness to the disease, the ever changing lifestyle, lack of exercise, dietary imbalance and a high intake of saturated and/or Trans fats amongst the population. In the past, multiple studies have also shown that regular consumption of almonds may help reduce low density lipoprotein (LDL “bad”) cholesterol levels, a recognized risk factor for CVD – especially amongst Indians.
The objective of this study was to estimate the cost-effectiveness of almond consumption in preventing coronary heart disease through changes in LDL cholesterol levels in the U.S. population, using both short-term base case analysis and 10-year risk prevention. The researchers developed a model to assess the relationship between eating 42.5g of almonds per day versus no almond intake. CVD parameters included the probabilities of increasing LDL levels, developing acute myocardial infarction (MI, or heart attack), MI-related surgeries, and death due to the disease and surgeries and the cost of disease and procedures in the U.S. population in 2012. The cost of almonds used in this research was also factored into the model and was based on price in the U.S. market in 2012, as well.
The base-case model used in this research, which was a study of 150 US adults with increased risk of type 2 diabetes, showed that eating 42.5g of almonds per day would result in an annual cost savings of $363 compared to eating no almonds. The almond eaters had reductions in CVD risk factors including LDL cholesterol, total cholesterol, body weight and Apoliprotein B (also known as Apo-B, the main protein found in harmful LDL cholesterol). These improved parameters decreased the average healthcare costs for treating CVD.
Speaking about the study, Regional Head-Dietetics, Max Healthcare – Delhi, Ritika Samaddar noted, “The study establishes a very positive correlation between almond consumption, heart health, and a derived cost benefit, each of which are relevant for a country like India where CVD cases are rising every day. While the health benefits of almonds have been analyzed by several other studies in the past, this new research also highlights a long term cost advantage of almond consumption which is very unique. So make sure to include almonds in your family and your diet, to lead a healthier and more cost efficient lifestyle.”
When the time horizon was expanded to 10 years, findings were similar in pattern: it cost non-almond eaters $2566 in CVD prevention compared to a cost of just $1806 for almond eaters, or a savings of $760.
Commenting on the study, Sheela Krishnaswamy, Nutrition and Wellness Consultant said, “The results of this new study are interesting to note. Owing to the genetic makeup, sedentary lifestyle, poor dietary regime and high salt intake, Indians are at higher risk of heart disease. If one develops the disease, it adds to the household’s medical expenses. Therefore, I suggest that people with a genetic history of CVD or those with established risk factors (high BP, diabetes, obesity etc.) for heart disease alter their diets to include a daily dose of almonds, among other things. In the long run, improving your lifestyle will have a positive impact not just on your heart health, but may also reduce overall medical expenses.”
Based on these analyses, researchers concluded that consuming 42.5g of almonds per day is a cost-effective strategy for preventing CVD in short term and potentially, up to 10 years.
Acknowledging the findings in the study, Madhuri Ruia, Pilates Expert and Diet & Nutrition Consultant commented, “It is interesting to note the long term viability of this study, especially in context of a country like India where CVD is one of the leading causes of mortality. Opting for healthier snacking options like almonds, is a small yet impactful investment that is sure to pay off in the long run, especially for people with high risk to CVD. So the next time you head to the supermarket, stock up on roasted, salted or raw almonds instead of unwholesome or fried snacks, to begin your journey towards a healthier lifestyle.”
###
Study at a Glance:
The Study: A decision model was developed for 42.5g of almonds per day vs no almond consumption and cardiovascular disease (CVD) in the US population. Parameters for the model were derived from the literature, which included the probabilities of increasing LDL cholesterol, developing acute myocardial infarction and stroke, treating myocardial infarction, dying from the disease and surgery, as well as the costs of the disease and procedures in the US population, and the quality-adjusted years. Sensitivity analyses were conducted for different levels of willingness to pay, the probalistic sensitivity analysis, 10-year risk prevention, different costs of procedures and almond prices, and patients with and without cardiovascular disease. The study aimed to examine the cost-effectiveness of almond consumption in CVD primary prevention.
Results: Almond eaters had a $363 lower cost and 0.02 higher quality-adjusted life years gain compared to the non-almond eaters in the base-case model used. The annual net monetary benefit of almond consumption was $1421 higher per person than no almond consumption, when the willingness to pay threshold was set at $50,000 for annual health care expenditure. Eating almonds was more cost-effective than not eating almonds in CVD prevention in all the sensitivity analyses.
Study Limitations: This study had several limitations, including a main constraint of lack of available data. LDL cholesterol was used as mediator of CVD risk, even though the ratio of total cholesterol/HDL may have been a better indication. However, researchers were only able to obtain the data of LDL-C response from study authors. Also, since there are a wide variety of health insurance options in the US, researchers were not able to summarize average premiums, deductibles and out of pocket expenses for CVD treatments, and average cost for each treatment was used instead. Therefore, results and conclusions may only apply to the uninsured. Other study limitations include the fact that the study focus was on a US population with increased risk of type 2 diabetes using costs of medical treatments and probabilities of developing diseases from studies conducted in the US. Therefore, result may not be generalizable to other countries. Finally, interpretation of results requires caution. Data inputs were constrained by the study design of the literature, especially the probabilities, since the findings were based on inputs from published literature instead of primary data from an intervention cohort. More data may be needed to estimate the costs of almonds and procedures over time.
Conclusion: Consuming 42.5g of almonds per day is a cost-effective approach to prevent cardiovascular disease in the short-term and potentially in the long-term.
