Understanding the Positive Effects of Extra Virgin Olive Oil on Cardiovascular Diseases

Cardiovascular dis­eases are the lead­ing cause of death glob­ally.

CVDs encom­pass a range of con­di­tions affect­ing the heart and blood ves­sels. The most preva­lent among these are coro­nary heart dis­ease, rheumatic heart dis­ease and cere­brovas­cu­lar dis­ease.

The New York State Department of Health recently reported that about 695,000 Americans die from heart dis­ease annu­ally, rep­re­sent­ing one in five deaths in the coun­try. Globally, the World Health Organization esti­mates that car­dio­vas­cu­lar dis­ease accounts for 32 per­cent of all deaths.

While car­dio­vas­cu­lar dis­eases are trig­gered by var­i­ous fac­tors, includ­ing genet­ics, pol­lu­tion and lifestyle, a grow­ing body of research links daily con­sump­tion of extra vir­gin olive oil, the high­est-qual­ity olive oil cat­e­gory, to sig­nif­i­cantly reduc­ing the risk of devel­op­ing car­dio­vas­cu­lar dis­eases.

The evi­dence behind olive oil’s deci­sive impact

A large-scale trial con­ducted on thou­sands of indi­vid­u­als in Spain dur­ing the 2010s demon­strated that adher­ence to the Mediterranean diet and daily con­sump­tion of olive oil sig­nif­i­cantly reduce car­dio­vas­cu­lar events in at-risk patients com­pared to a generic low-fat diet.

The PREDIMED (PREvención con DIeta MEDiterránea) study, pub­lished in the New England Journal of Medicine, laid the foun­da­tions for fur­ther research world­wide.

The Seven Countries Study, con­ducted since the 1950s across the U.S., Finland, Netherlands, Italy, Greece, Yugoslavia and Japan, also con­firmed the crit­i­cal role of olive oil and the Mediterranean diet in reduc­ing car­dio­vas­cu­lar dis­eases.

This exten­sive epi­demi­o­log­i­cal study involved 12,000 mid­dle-aged men, reveal­ing that daily con­sump­tion of unsat­u­rated fats, such as olive oil, and adher­ence to the Mediterranean diet sig­nif­i­cantly lower heart dis­ease risks.

These stud­ies con­firmed the sig­nif­i­cant impact of dietary behav­ior on cho­les­terol lev­els and other con­di­tions related to the devel­op­ment of car­dio­vas­cu­lar dis­eases.

As a result of these stud­ies, hun­dreds of sci­en­tific pub­li­ca­tions have explored the unique role of olive oil in human health in recent decades.

Olive oil’s ben­e­fi­cial effects are attrib­uted mainly to its high con­tent of monoun­sat­u­rated fats. The polyphe­nols found in the high­est grade of olive oil, extra vir­gin olive oil, fur­ther enhance these health ben­e­fits.

The role of monoun­sat­u­rated fatty acids (MUFAs)

Oleic acid, a monoun­sat­u­rated fatty acid (MUFA), is a crit­i­cal com­po­nent of olive oil and is cred­ited with many of the sig­nif­i­cant health ben­e­fits asso­ci­ated with its con­sump­tion.

“It is impor­tant to note that extra vir­gin olive oil con­sists of 60 to 83 per­cent MUFAs,” said Bruno Tuttolomondo, a full pro­fes­sor of inter­nal med­i­cine at the University of Palermo and direc­tor of the inter­nal med­i­cine with stroke care unit at Policlinico Hospital in Palermo.

“The remain­ing com­po­si­tion includes small per­cent­ages of sat­u­rated fatty acids, such as palmitic acid and stearic acid,” he added. ​“Along with polyun­sat­u­rated fats, monoun­sat­u­rated fats are con­sid­ered ​‘good fats.’”

Tuttolomondo said research indi­cates that a high per­cent­age of MUFAs play a cru­cial role in pre­vent­ing car­dio­vas­cu­lar dis­eases.

“This is because MUFAs influ­ence cho­les­terol and LDL lev­els, reduce LDL oxi­da­tion and affect the com­po­si­tion of ath­er­o­scle­rotic plaques, thereby exert­ing a car­dio­pro­tec­tive role,” he said.

LDL stands for a low-den­sity com­bi­na­tion of fat and pro­tein. It is a type of cho­les­terol that can accu­mu­late in the blood­stream and form plaques in the arter­ies, lead­ing to ath­er­o­scle­ro­sis.

“MUFAs are not the only impor­tant com­po­nents of extra vir­gin olive oil, but they are the most abun­dant,” Tuttolomondo said. ​“This alone qual­i­fies extra vir­gin olive oil as one of the ​‘good fats.’”

Polyphenols are crit­i­cal to CVD risk reduc­tion

Polyphenols are a diverse group of hun­dreds of sub­stances found in many foods.

Extra vir­gin olive oil con­tains dozens of these polyphe­nols, which are rare and espe­cially valu­able due to their high bioavail­abil­ity.

This means that, once con­sumed, they reach areas of the body where they can exert their effects, includ­ing potent antiox­i­dant and anti-inflam­ma­tory prop­er­ties.

“Polyphenols cer­tainly play a role in car­dio­vas­cu­lar health and are the sub­ject of sig­nif­i­cant research due to their car­dio­pro­tec­tive actions,” Tuttolomondo said.

One of the most researched polyphe­nols for cho­les­terol and car­dio­vas­cu­lar dis­eases is oleu­ropein.

“Many researchers, includ­ing [Francesco] Violi’s team at La Sapienza University in Rome, are inves­ti­gat­ing oleu­ropein,” Tuttolomondo said. ​“They dis­cov­ered that oleu­ropein helps sta­bi­lize lipid plaques and reduce LDL oxi­da­tion.”

“They also found that it mod­u­lates the impact of dia­betes on vas­cu­lar and car­dio­vas­cu­lar health,” he added.

EVOO might enhance dia­betes pre­ven­tion

According to the World Health Organization, 422 mil­lion peo­ple have dia­betes glob­ally. Research has shown that extra vir­gin olive oil and adher­ence to the Mediterranean diet can sig­nif­i­cantly lower the risk of devel­op­ing the dis­ease.

Diabetes is linked to car­dio­vas­cu­lar dis­eases because it can lead to exces­sive sugar in the blood, which can dam­age the blood ves­sels that sup­ply the heart. This dam­age can reduce the sup­ply of oxy­gen and nutri­ents to the heart, sig­nif­i­cantly increas­ing the risk of heart dis­ease.

“For some time, the impact of extra vir­gin olive oil on dia­betes was eval­u­ated indi­rectly,” Tuttolomondo said. ​“In numer­ous stud­ies, includ­ing those con­ducted by my research group, we ana­lyzed adher­ence to the Mediterranean diet, which con­sid­ers extra vir­gin olive oil the pri­mary fat. It is well known that adher­ence to the Mediterranean diet results in a lower inci­dence of dia­betes.”

Further research has built on these find­ings. ​“We now know that extra vir­gin olive oil and phe­nols such as oleu­ropein have effects sim­i­lar to some com­pounds used in dia­betes ther­a­pies, as they increase insulin sen­si­tiv­ity,” Tuttolomondo said.

“We now have strong evi­dence of the pre­ven­tive role and reg­u­la­tion of glycemic lev­els by daily and reg­u­lar con­sump­tion of extra vir­gin olive oil, espe­cially when con­sumed for many years,” he added.

“While you can­not expect to lower blood sugar by sim­ply eat­ing a salad with extra vir­gin olive oil, daily, famil­ial and tra­di­tional con­sump­tion of extra vir­gin olive oil has proven effec­tive in reduc­ing the preva­lence of dia­betes,” he noted.

Olive oil is the health­ier, tastier fat choice

“One of the unique qual­i­ties of extra vir­gin olive oil is its fla­vor. In addi­tion to its wide-rang­ing health ben­e­fits, it also offers an exquis­ite taste,” Tuttolomondo said. ​“No other cook­ing fat com­bines favor­able organolep­tic prop­er­ties with ben­e­fi­cial nutri­ents like extra vir­gin olive oil. It is a small mir­a­cle, com­bin­ing health and taste.”

However, he empha­sized that other fats can also ben­e­fit human health.

“Consider polyun­sat­u­rated fats like Omega‑3 and Omega‑6, which have been shown to play a role in car­dio­vas­cu­lar dis­ease pre­ven­tion. Still, none of them com­pare to extra vir­gin olive oil in daily use,” Tuttolomondo said. ​“Extra vir­gin olive oil is the cen­ter­piece of every lunch and din­ner for those who fol­low the Mediterranean diet.”

“When we talk about Omega‑3 and Omega‑6, we think of fats from blue fish or almond extracts. While some peo­ple eat five almonds for lunch, it’s imprac­ti­cal to base a diet on almonds,” he added.

Healthy fats like pump­kin seed or flaxseed oil have ben­e­fi­cial pro­files but do not offer the same organolep­tic prop­er­ties as extra vir­gin olive oil.

“They are ben­e­fi­cial fats, but con­sider flaxseed oil; it has no fla­vor, so it can­not moti­vate peo­ple through taste,” Tuttolomondo said. ​“In my opin­ion, we need to attract peo­ple to pre­ven­tion by appeal­ing to their sense of taste.”

Meanwhile, avo­cado oil has been the sub­ject of sev­eral stud­ies. ​“From a palata­bil­ity stand­point, it is vir­tu­ally fla­vor­less,” Tuttolomondo said. ​“It con­tains a sig­nif­i­cant amount of polyun­sat­u­rated fats, but I don’t think there are enough stud­ies on its polyphe­no­lic con­tent.”

How much EVOO should be con­sumed?

Extra vir­gin olive oil should be con­sumed daily to reap its health ben­e­fits.

However, not all extra vir­gin olive oils are the same. While oleu­ropein and other polyphe­nols can sig­nif­i­cantly ben­e­fit human health, the amount and type of phe­nols vary among extra vir­gin olive oils.

“Polyphenol con­tent depends on fac­tors includ­ing cul­ti­var, cul­ti­va­tion area, pro­cess­ing meth­ods, and exter­nal tem­per­a­ture,” Tuttolomondo said. ​“There is a thresh­old of polyphe­nol con­tent that char­ac­ter­izes a high-qual­ity extra vir­gin olive oil.”

“Polyphenols are one of the cri­te­ria for eval­u­at­ing extra vir­gin olive oil,” he added. To have a sig­nif­i­cant effect, it should con­tain no less than 250 to 350 mil­ligrams per kilo­gram.”

“It has been hypoth­e­sized that higher lev­els of polyphe­nols cor­re­spond to greater car­dio­pro­tec­tive effects,” Tuttolomondo con­tin­ued. ​“However, we should always remem­ber the key role played by MUFAs, which are the foun­da­tion of all extra vir­gin olive oils.”

While exces­sive olive oil con­sump­tion can lead to exces­sive calo­rie intake, researchers have worked to define rec­om­mended daily doses of extra vir­gin olive oil.

“Many stud­ies indi­cate that 20 grams of extra vir­gin olive oil can opti­mize the ben­e­fits of the Mediterranean diet,” Tuttolomondo said. ​“This equates to about one to one and a half table­spoons.”

“However, inter­ven­tion stud­ies have eval­u­ated up to four table­spoons per day for car­dio­vas­cu­lar effects,” he added. ​“Considering weight reg­u­la­tion and over­all caloric intake, I would say that the more EVOO we con­sume, the bet­ter.”

• World Health Organization
• New York State Department of Health