Introduction: Olive oil's health benefits are widely known and extensively documented; its advantages are widespread, covering numerous areas of human health. Clinical and experimental data indicate that a Mediterranean Diet (MedDiet) with Extra Virgin Olive Oil (EVOO) lowers the risk of illnesses associated with oxidative stress, chronic inflammation, and weakened immunity, including cancer and cardiovascular disease (CVD). The European Food Safety Authority (EFSA) confirms that olive oil's polyphenols help protect blood lipids against oxidative damage; thus, EVOO, crucial in the MedDiet, could be a functional food component. Olive oils must contain at least 5 mg of Hydroxytyrosol (HYTY) and its derivatives (oleuropein and Tyrosol (TY)) per 20 g to qualify for the EFSA-approved health claim. To provide a summary of clinical study results, this systematic review assessed the impact of Virgin olive oil (VOO) consumption on cardiovascular risk and disease prevention. Methods: The systematic review's studies were collected from PubMed, Cochrane, Web of Science, and Scopus following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Population Intervention Comparison Outcome Population (PICO) framework. Results: Seventeen clinical studies were identified, which highlighted the association between VOO consumption (including EVOO) and a reduced risk of cardiovascular disease. Particularly, improvements in biomarkers involved in cardiometabolic pathways and subsequent cardiovascular events were recorded. The beneficial effect was attributed to the polyphenols contained in EVOO. Indeed, EVOO supplementation as part of the Mediterranean diet could improve patients' quality of life in secondary prevention by demonstrating a positive correlation with the cardioprotective role of polyphenols. Discussion: A balanced diet with VOO represents a simple yet potent method to counteract metabolic dysfunctions associated with CVD. Despite these results, further multicenter clinical studies with a wider range of patients are required to confirm and better understand EVOO's effects on the prevention of cardiovascular risk.
Keywords: atherosclerosis; cardiovascular disease; endothelial dysfunction; inflammation; metabolic dysfunction; oxidative stress; polyphenols; virgin olive oil.