Nuts are part of the Mediterranean tradition. For millennia, tree nuts have been in the region. Results of an epidemiological study conducted among California Adventists provide strong evidence that frequent consumption of nuts have a protective effect on both fatal and non-fatal ischaemic heart disease events. The unique nutrient composition of nuts makes it plausible that nuts favourably affect heart disease risk factors and interfere with the process of atherogenesis. Results of recently conducted human nutritional studies, with varying degrees of methodological rigour, all seem to indicate that eating nuts lowers serum cholesterol and favourably modifies the lipoprotein profile. The effects of nut consumption on other cardiovascular disease risk factors deserve further exploration.