This randomized, controlled, cross-over trial revealed no significant impact of the incorporation of 85 g/day almonds to a NCEP Step 1 diet on FMD and other measures of vascular reactivity. Compliance to the almond intervention was good, as confirmed by an elevation of α-tocopherol status, and was associated with an improvement of dietary quality reflected by increased intakes of fiber, amino acids (especially arginine), the minerals calcium and magnesium, choline, and proanthocyanins. Positive trends were observed in a reduction of circulating VCAM-1 and an increase of urinary NO, though these changes did not achieve statistical significance. The addition of almonds to the control diet improved dietary quality beyond that already achieved by the NCEP step 1 diet, particularly by increasing the intake of fiber, calcium, magnesium, choline, proanthocyanins, and arginine. The generous consumption of almonds was safe in CAD patients, absent any indication of adverse interactions with their polypharmacy regimens. Overall, our results provide further support for patients with CVD that almonds can be part of a healthy diet.