Olive Oil Consumption and Cardiovascular Risk

Study Questions:

Is olive oil (monounsaturated fatty acid) intake associated with total cardiovascular disease (CVD), coronary heart disease (CHD), and stroke risk?

Methods:

The study included 61,181 women from the Nurses’ Health Study (1990-2014) and 31,797 men from the Health Professionals Follow-up Study (1990-2014) who were free of cancer, heart disease, and stroke. Diet was assessed using food frequency questionnaires (130 items) at baseline and every 4 years. CV risk factors were self-reported. The primary outcome was major CVD defined as a composite of nonfatal myocardial infarction (MI), nonfatal stroke, or fatal stroke, fatal MI, and other CV deaths. Cox proportional hazards regressions were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

Results:

Mean consumption of olive oil increased from 1.30 g/d in 1990 to 4.2 g/d in 2010, with decrease in margarines. During 24 years of follow-up, there were 9,797 incident cases of CVD, including 6,034 CHD and 3,802 stroke cases. After adjusting for major diet and lifestyle factors, compared with nonconsumers, those with higher olive oil intake (>1/2 tablespoon/d or >7 g/d) had a 14% lower risk of CVD (pooled HR, 0.86 [0.79, 0.94]) and 18% lower risk of CHD (pooled HR, 0.82 [0.73, 0.91]). No significant associations were observed for total or ischemic stroke. Replacing 5 g/d of margarine, butter, mayonnaise, or dairy fat with the equivalent amount of olive oil was associated with 5-7% lower risk of total CVD and CHD. No significant associations were observed when olive oil was compared with other plant oils combined. In a subset of participants, higher olive oil intake was associated with lower levels of circulating inflammatory biomarkers and a better lipid profile.

Conclusions:

Higher olive oil intake was associated with a lower risk of CHD and total CVD in two large prospective cohorts of US men and women. The substitution of margarine, butter, mayonnaise, and dairy fat with olive oil could lead to lower risk of CHD and CVD.

Perspective:

This study of well-educated health professionals is the first in the United States to show the relative value of higher intake of olive oil for preventing CHD and CVD. It was conducted in the era that margarine was primarily trans fatty acids and would not apply to the present soft and liquid margarines. The benefit attributed to olive oil is not simply the substitution for saturated fatty acid. The modest benefit of olive oil in the United States occurred at relatively low olive oil intake (average 12 g/day). In contrast, the Mediterranean diet generally has over 25 g/day. In European studies, a healthy cohort had a 7% reduction in CHD risk for each 10 g/d increase in olive oil; extra virgin olive oil reduced cerebrovascular events by 31% in a high-risk group, and regular olive oil was associated with a 44% lower risk of CHD after about 7.8 years in Italian women survivors of an MI. Amongst the benefits of olive oil include positive effects on inflammation, endothelial function, hypertension, insulin sensitivity, and diabetes.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Statins, Diet

Keywords: Biological Markers, Brain Ischemia, Butter, Cardiovascular Diseases, Coronary Disease, Diet, Mediterranean, Diet, Fatty Acids, Monounsaturated, Inflammation, Life Style, Lipids, Margarine, Myocardial Infarction, Primary Prevention, Risk Factors, Stroke, Trans Fatty Acids, Vascular Diseases


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