Physicians' Academy for Cardiovascular Education

Higher olive oil consumption associated with lower CV and CHD risk in U.S. adults

Olive Oil Consumption and Cardiovascular Risk in U.S. Adults

Literature - Guasch-Ferré M, Liu G, Li Y et al., - J Am Coll Cardiol. 2020. doi: 10.1016/j.jacc.2020.02.036.

Introduction and methods

Consumption of olive oil has been associated with lower CV risk, as shown in ecological studies on a country-level [1], in clinical trials [2, 6] and in observational studies [3-5]. In addition, the findings from a recent meta-analysis suggested that olive oil consumption was protective of stroke, although there were inconsistencies between the studies which assessed CHD as endpoint [7]. However, all of these studies were limited to populations in Mediterranean countries.

The present study aimed to investigate, in the U.S. population, associations between CV risk and olive oil consumption, and estimate risk of CVD when consumption of margarine, butter, mayonnaise, dairy fat and plant oils were replaced by olive oil. In addition, the association between olive oil intake categories and blood lipid levels was analyzed. Two large U.S. prospective cohorts were used with a 24 years follow-up period, including the Nurse’s Health Study (NHS) (n=61181 female registered nurses ) and the Health Professional’s Follow-up Study (HPFS) (n=31797 male health professionals). Olive oil consumption was measured every 4 years with a food frequency questionnaire (FFQ), asking participants how often, on average, they had consumed specific foods, as well as types of fats, oils, and brand or type of oils used for cooking and added at the table in the preceding year. Olive oil intake was categorized into four categories: (1) never or less than once per month (NHS: n=32673, HPFS: n=16073), (2) >0 to ≤1 teaspoon (>0 to ≤4.5 g/d) (NHS: n=22918, HPFS: n=12853), (3) >1 teaspoon to ≤1/2 tablespoon (>4.5-≤7 g/d) (NHS: n=2412, HPFS: n=1246), and (4) >1/2 tablespoon (>7 g/d) (NHS: n=3178, HPFS: n=1625). Primary outcome measure was major CVD defined as a combined endpoint of nonfatal myocardial infarction, non-fatal stroke, or fatal CVD (fatal stroke, fatal myocardial infarction, and other CV death).

Main results


More consumption of olive oil was associated with lower CV risk and lower CHD risk in two large cohorts of men and women from the U.S. In addition, substituting margarine, butter, mayonnaise, and dairy fat with olive oil resulted in lower risk of CHD and CVD. Finally, in a subset of participants, higher olive oil intake was associated with lower levels of inflammatory biomarkers and a better lipid profile. In conclusion, intake of plant-based healthy fats can improve diet quality and contribute to CVD prevention in the general population.


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