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

Abstract

Background: Olive oil intake has been associated with lower risk of cardiovascular disease (CVD) in Mediterranean populations, but little is known about these associations in the U.S population.

Objectives: This study sought to examine whether olive oil intake is associated with total CVD, coronary heart disease (CHD), and stroke risk.

Methods: This study included 61,181 women from the Nurses' Health Study (1990 to 2014) and 31,797 men from the Health Professionals Follow-up Study (1990 to 2014) who were free of cancer, heart disease, and stroke at baseline. Diet was assessed using food frequency questionnaires at baseline and then every 4 years. Cox proportional hazards regressions were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: During 24 years of follow-up, this study documented 9,797 incident cases of CVD, including 6,034 CHD cases and 3,802 stroke cases. After adjusting for major diet and lifestyle factors, compared with nonconsumers, those with higher olive oil intake (>0.5 tablespoon/day or >7 g/day) had 14% lower risk of CVD (pooled HR: 0.86; 95% CI: 0.79 to 0.94) and 18% lower risk of CHD (pooled HR: 0.82; 95% CI: 0.73 to 0.91). No significant associations were observed for total or ischemic stroke. Replacing 5 g/day of margarine, butter, mayonnaise, or dairy fat with the equivalent amount of olive oil was associated with 5% to 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 lower risk of CHD and total CVD in 2 large prospective cohorts of U.S. men and women. The substitution of margarine, butter, mayonnaise, and dairy fat with olive oil could lead to lower risk of CHD and CVD.

Keywords: cardiovascular disease; coronary heart disease; olive oil; plant oils; stroke.

Figure 1.. Associations between olive oil intake at baseline and inflammatory biomarkers in the NHS, NHS2, and HPFS.

Linear regressions were used to analyze the association between olive oil intake categories (cumulative average scores of 1990 and 1994 in NHS and HPFS, and 1991 and 1995 in NHSII) and blood lipid levels assessed using blood samples (1989-1990 in NHS, 1993-1995 in HPFS, and 1996-1999 in NHSII). Multivariable models were adjusted for study cohort, age, fasting status, body mass index, ethnicity (white, non-white), Southern European/Mediterranean ancestry, smoking status, alcohol intake, physical activity, family history of diabetes, family history of myocardial infarction, baseline diabetes mellitus, baseline hypertension and antihypertensive medication, baseline hypercholesterolemia and lipid-lowering medication, steroid use, multivitamin use, aspirin use, in women postmenopausal status and menopausal hormone use [premenopausal, postmenopausal (no, past, or current hormone use), total energy intake, trans, saturated and polyunsaturated fatty acids and case-control status in original sub-studies. CI, confidence interval; SD, standard deviation; sICAM-1, soluble intercellular adhesion molecule-1; TNFα-R2, tumor necrosis factor-α receptor 1 and 2; and hsCRP, high-sensitive C-reactive protein.

Central Illustration.. Hazard Ratios for Cardiovascular Disease, Coronary Heart Disease and Stroke associated with substitution of 5 g/d of olive oil for equivalent amounts of other fats.

Abbreviations: NHS, Nurses’ Health Study; HPFS, Health Professional’s Follow-up Study. Multivariate-adjusted models were adjusted for age (years), ethnicity (white, non-white), Southern European/Mediterranean ancestry, smoking status (never, former, current smoker 1-14 cigarettes per day, 15-24 cigarettes per day, or ≥ 25 cigarettes per day), alcohol intake (0, 0.1-4.9,5.0-9.9,10.0-14.9, and ≥ 15.0 g/d), physical activity (<3.0,3.0-8.9,9.0-17.9,18.0-26.9,≥27.00 metabolic equivalent task-h/week), family history of diabetes, family history of myocardial infarction, family history of cancer, baseline diabetes mellitus, baseline hypertension or antihypertensive medication use, baseline hypercholesterolemia or cholesterol-lowering medication use, multivitamin use, aspirin use, in women postmenopausal status and menopausal hormone use [premenopausal, postmenopausal (no, past, or current hormone use), total energy intake (kilocalories per day), body mass index (kg/m²), for red meat, fruits and vegetables, nuts, soda, whole grains intake (in quintiles), trans fat, and mutually adjusted for other types of fat. Results were pooled with the use of the fixed-effects model. Horizontal lines represent 95% confidence intervals.