IJCS | Volume 32, Nº2, May/June 2019

277 Figure 1 - Effects of nut consumption. The hypocholesterolemic effect is related to the rich content of phytosterols, non-nutritive components of all plants, able to displace cholesterol from intestinal micelles, reducing its absorption. Nuts are involved in the modulation of hypertension due to their high content of MUFA and PUFA, and which can reduce serum levels of thromboxane-A2, an important vasoconstrictor. Nuts are also rich in magnesium, stimulating the production of nitrous oxide and blockage of calcium channels, thus promoting vasodilatation. Concerning the antioxidant properties of Brazil nuts, its high content of selenium is particularly due to its presence in the glutathione peroxidase, an important enzyme that prevents the accumulation of reactive species of oxygen. Silva et al. Nuts and cardiovascular diseases Int J Cardiovasc Sci. 2019;32(3)274-282 Review Article baseline. The authors showed a lower incidence of hypertension in usual consumers of nuts compared to non-consumers, although they did not consider the consumption of salt and body weight changes, two major factors associated with the risk of hypertension. The other study, conducted with Spanish university graduates followed-up for a median of 4.3 years in the SUN cohort, did not observe any association between nut consumption and the incidence of hypertension, after adjustment for several confounders. 15,16 The effects of nuts on novel coronary heart disease risk factors including oxidative stress, inflammation and vascular reactivity have been evaluated, 6 and showed to promote beneficial effects on vascular reactivity by decreasing endothelial activation and improving flow-mediated vasodilatation 2 and nitric oxide-induced endothelial relaxation. As nuts are an excellent source of antioxidants, it’s no coincidence that they are related to an improvement of the oxidative status. 6 A study that evaluated oxidative stress and endothelial function in metabolic syndrome patients showed that the consumption of 30 g of mixed nuts for 12 weeks reduced significantly DNA damage (measured by the 8-oxo-dG urinary excretion). 17 Inflammatory biomarkers were also assessed and showed a significant decrease in interleukin-6 (IL-6) after nut consumption compared with the control group. After adjustment for changes in body weight, this statistical significance was reduced; however, there was still a borderline improvement in inflammatory markers in these patients. 18 The effect of walnuts on inflammatory biomarkers in subjects with cardiovascular risk was also assessed in a cross-over study. Men and postmenopausal women (age ≥ 45 years and ≥ 50 years, respectively) were included in the study. Participants were obese or overweight and had one or more of the following risk factors: smoking habits, hypertension, familial hypercholesterolemia and type 1 diabetes. Intervention consisted of two 5-week