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Cardiovascular Disease Systematic Literature Review

Cardiovascular disease

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Reference: Martinez-Gonzalez, M.A., L.J. Dominguez, and M. Delgado-Rodriguez, Olive oil consumption and risk of CHD and/or stroke: a meta-analysis of case-control, cohort and intervention studies. Br J Nutr, 2014. 112(2): p. 248-59.

One-sentence summary: Olive oil consumption significantly reduced the risk of cardiovascular disease (CVD) risk and stroke, but not specifically for coronary heart disease (CHD) risk.

Study type: A systematic review and meta-analysis of 9 studies (3 case-controls, 5 cohorts and 1 clinical trial).

Diet: Higher intakes of olive oil (any type).

Outcomes measured: Cardiovascular disease (CVD)- a coronary heart disease (CHD) event (both fatal and non-fatal myocardial infarction) or stroke (either ischaemic or haemorrhagic).

Population: All studies were from Mediterranean countries, with participants who had no prior CVD diagnosis.

Key results:

  • CHD: No significant association between olive oil consumption and the risk of CHD (7 studies).
  • Stroke: A significant inverse association between olive oil and the risk of stroke (3 studies): 24% reduced risk of stroke for an additional 25 grams of olive oil per day (95 % CI 0·67, 0·86; P<0·001).
  • CVD (CHD or stroke as endpoint): Significant inverse association between olive oil and risk of CVD (n = 9 studies): 18% reduced risk of CVD for an additional 25 grams of olive oil per day (95 % CI 0·70, 0·96; P=0·01).

Quality assessment:

The quality of the 8 observational studies was assessed using the modified Newcastle–Ottawa Quality Assessment Scale. A ‘high’ score was awarded for 6 of the 8 studies.


  • Substantial heterogeneity was observed among the studies for CHD.
  • There were a small number of studies available, and the different study designs were combined.
  • The type of olive oil (e.g. virgin olive oil vs. ordinary refined variety) was not taken into account in most of the studies.
  • All studies were conducted in Mediterranean countries and the applicability of these findings to other populations is unknown.
  • There was evidence found for publication bias.

The bottom line: There is evidence for an association between olive oil consumption and reduced risk of cardiovascular disease, and specifically for stroke. However, no significant protection was found for CHD overall, suggesting that the effect for stroke may be driving the relationship. Further studies that better distinguish between extra virgin olive oil vs. ordinary olive oil with respect the risk of CHD are needed, since the phenolic concentration in extra virgin olive oil is much higher.

Other reviews:

Dinu, M., et al., Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials. Eur J Clin Nutr, 2018. 72(1): p. 30-43.

Nowson, C.A., et al., The Impact of Dietary Factors on Indices of Chronic Disease in Older People: A Systematic Review. J Nutr Health Aging, 2018. 22(2): p. 282-296.

Sanches Machado d’Almeida, K., et al., Mediterranean Diet and Other Dietary Patterns in Primary Prevention of Heart Failure and Changes in Cardiac Function Markers: A Systematic Review. Nutrients, 2018. 10(1).

Grosso, G., et al., A comprehensive meta-analysis on evidence of Mediterranean diet and cardiovascular disease: Are individual components equal? Crit Rev Food Sci Nutr, 2017. 57(15): p. 3218-3232.

Rosato, V., et al., Mediterranean diet and cardiovascular disease: a systematic review and meta-analysis of observational studies. Eur J Nutr, 2017.

Bloomfield, H.E., et al., Effects on Health Outcomes of a Mediterranean Diet With No Restriction on Fat Intake: A Systematic Review and Meta-analysis. Ann Intern Med, 2016. 165(7): p. 491-500.

Liyanage, T., et al., Effects of the Mediterranean Diet on Cardiovascular Outcomes-A Systematic Review and Meta-Analysis. PLoS One, 2016. 11(8): p. e0159252.

Sayon-Orea, C., S. Carlos, and M.A. Martinez-Gonzalez, Does cooking with vegetable oils increase the risk of chronic diseases?: a systematic review. Br J Nutr, 2015. 113 Suppl 2: p. S36-48.

Sleiman, D., M.R. Al-Badri, and S.T. Azar, Effect of mediterranean diet in diabetes control and cardiovascular risk modification: a systematic review. Front Public Health, 2015. 3: p. 69.

Grosso, G., et al., Mediterranean diet and cardiovascular risk factors: a systematic review. Crit Rev Food Sci Nutr, 2014. 54(5): p. 593-610.

Schwingshackl, L. and G. Hoffmann, Monounsaturated fatty acids, olive oil and health status: a systematic review and meta-analysis of cohort studies. Lipids Health Dis, 2014. 13: p. 154.

Sofi, F., et al., Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score. Public Health Nutr, 2014. 17(12): p. 2769-82.

Psaltopoulou, T., et al., Mediterranean diet, stroke, cognitive impairment, and depression: A meta-analysis. Ann Neurol, 2013. 74(4): p. 580-91.

Rees, K., et al., ‘Mediterranean’ dietary pattern for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev, 2013(8): p. CD009825.

Sherzai, A., et al., Stroke, food groups, and dietary patterns: a systematic review. Nutr Rev, 2012. 70(8): p. 423-35.

Kastorini, C.M., et al., Mediterranean diet and coronary heart disease: is obesity a link? – A systematic review. Nutr Metab Cardiovasc Dis, 2010. 20(7): p. 536-51.

Sofi, F., et al., Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr, 2010. 92(5): p. 1189-96.

Tyrovolas, S. and D.B. Panagiotakos, The role of Mediterranean type of diet on the development of cancer and cardiovascular disease, in the elderly: a systematic review. Maturitas, 2010. 65(2): p. 122-30.

Mente, A., et al., A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med, 2009. 169(7): p. 659-69.

Roman, B., et al., Effectiveness of the Mediterranean diet in the elderly. Clin Interv Aging, 2008. 3(1): p. 97-109.

Van Horn, L., et al., The evidence for dietary prevention and treatment of cardiovascular disease. J Am Diet Assoc, 2008. 108(2): p. 287-331.

Sofi, F., et al., Adherence to Mediterranean diet and health status: meta-analysis. BMJ, 2008. 337: p. a1344.

Hooper, L., Primary prevention of CVD: diet and weight loss. BMJ Clin Evid, 2007. 2007.

Serra-Majem, L., B. Roman, and R. Estruch, Scientific evidence of interventions using the Mediterranean diet: a systematic review. Nutr Rev, 2006. 64(2 Pt 2): p. S27-47.

Panagiotakos, D.B., et al., Can a Mediterranean diet moderate the development and clinical progression of coronary heart disease? A systematic review. Med Sci Monit, 2004. 10(8): p. RA193-8.