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Olive Oil_Fact Sheet 05

Olive Oil in the Prevention of Cardiovascular Risk Factors and Coronary Heart
Disease latest scientific evidence
Atherosclerosis and coronary heart disease (CHD) are caused by a combination of
different factors, many of which are modifiable. Dietary factors, particularly the
intake of dietary fats, are directly implicated in the development of CHD.
Most Western and North European diets are high in saturated fatty acids (SFAs), and
this correlates strongly with the high rates of CHD morbidity and mortality seen in
these areas. In contrast, in Mediterranean countries, where people consume their
traditional diet and most fat calories are derived from olive oil, there is a low
incidence of CHD.
Evidence is mounting that olive oil, through its beneficial effects on lipid metabolism
(for details see fact sheet "olive oil and its effects on lipid metabolism"), blood
pressure, diabetes, and clotting mechanisms, plays a major role in the prevention of
CHD.
Olive oil and hypertension
Scientific studies have identified a strong relationship between diet and blood
pressure. Vegetarians and people who have a Mediterranean-style diet tend to eat
more olive oil, cereals, vegetables and fruit and less food containing saturated fatty
acids such as butter, dairy products, cheese and meat. Blood pressure is generally
lower in these groups of people than in other populations.
Although it has not yet been established exactly which elements are responsible for
the antihypertensive effects of the Mediterranean-style diet, studies suggest that a
combination of favourable factors (see box) leads to lower blood pressure.
A recent study suggests that the addition of olive oil to an otherwise unchanged diet
can have a significant blood pressure-lowering effect an effect that appears to be
unique to olive oil, and not just related to its MUFA component.
Favourable factors in the Mediterranean diet:
Low saturated fatty acids (SFAs)
High monounsaturated fatty acids (MUFAs, from olive oil)
High complex carbohydrates and fibre
High micronutrients (i.e. potassium, calcium, magnesium and vitamins)
Low salt
Olive oil and diabetes
Dietary manipulation and weight reduction are vital for the prevention and treatment
of non-insulin-dependent diabetes mellitus (NIDDM). At-risk patients and those with
NIDDM have in the past been strongly advised to reduce their total fat intake by
reducing the intake of saturated fatty acids and to increase their intake of complex
carbohydrates.
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Some investigators, however, have found that a high-carbohydrate, low-fat diet may
aggravate triglyceridaemia, and the use of a MUFA-enriched diet with a lower
carbohydrate content has therefore been advocated for patients with NIDDM. Diets
that are high in MUFA and low in SFA appear to improve lipid profiles and are
associated with better glycaemic control than a high-carbohydrate diet.
The typical Mediterranean diet, which is high in fibre-rich complex carbohydrates
and MUFA and low in SFA, is therefore an ideal diet for diabetics. The absolute fat
content of the diet can be altered on a daily basis to suit individual requirements by
varying the amount of olive oil used.
Olive oil and obesity
Obesity undoubtedly increases the risk of cardiovascular events because of its
detrimental effects on lipid profiles and blood pressure, and its association with
NIDDM.
Calorifically dense foods and thus those high in fat are believed to be a major cause
of obesity. Therefore, the traditional Mediterranean diet, which is based on cereals,
vegetables and legumes, which are characterised by a low energy density appears to
be appropriate for the prevention of obesity despite its relatively high amount of
olive oil. Epidemiological studies show a lower prevalence of overweight and obesity
in Mediterranean countries.
Olive oil and thrombogenic risk factors
There is evidence that several coagulation factors are influenced by nutritional
factors. It has been shown that dietary n-3 (omega-3) PUFA exert beneficial effects
on platelet function, while the effects of n-6 (omega-6) PUFA on thrombosis are still
contradictory. Although direct evidence for a beneficial effect of MUFA on the
coagulation system is not yet available, the majority of thrombosis studies suggest
that a Mediterranean style diet with its above mentioned characteristics meets the
requirements for the prevention of thrombosis.
Olive Oil and Coronary Heart Disease
Epidemiological studies
The Seven Countries Study, which was an important study ever to investigate the
relationship between the Mediterranean diet and coronary heart disease (CHD) found
a direct relationship between the consumption of MUFA and survival at 15 years.
Nearly 13,000 men (aged 4059 years) entered the study, and death rates due to CHD
during the 15-year follow-up period were found to be lowest in countries in which
MUFA intake was high and SFA intake was low.
Countries participating in the Seven Countries Study
Italy
Greece
Yugoslavia (former)
The Netherlands
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Finland
USA
Japan

Evidence from the Greek Island of Crete, which had the lowest mortality from CHD
during the study, clearly showed that the cholesterol-lowering properties of oleic acid
(largely from olive oil) are combined with other beneficial properties of the
Mediterranean diet to provide substantial cardioprotection.
Unfortunately, since the start of the Seven Countries Study in the early 1960s,
ongoing changes in eating habits throughout the Mediterranean appear to have
reduced cardiovascular health across the region.
Food survey data indicate a pronounced increase in the consumption of animal foods
(meat, milk and dairy products) and edible fats other than olive oil. These changes
have been accompanied by increases in several cardiovascular risk factors including
higher cholesterol levels, more obesity and a higher incidence of hypertension. These
trends must be reversed by preserving and promoting traditional diets within the
Mediterranean region.
Nonetheless, despite the increased consumption of animal products, recent
epidemiological data from 19921994 still show a clear benefit of a Mediterraneanstyle diet, with mortality rates from CHD substantially lower in Mediterranean
regions than in Western Europe and the USA.
Intervention studies
Most dietary intervention studies have been oriented towards a reduction in saturated
fat and an increase in carbohydrates and/or polyunsaturated fat (PUFA). The positive
findings from these studies have indeed confirmed the need to reduce the amount of
saturated fat in the diet.
Until now no epidemiological intervention study has been conducted which has
especially investigated the effect of MUFA in primary prevention of CHD. However,
numerous controlled dietary studies have shown that MUFA-rich diets effectively
lower serum total and LDL cholesterol, which, in turn, reduces the incidence of
ischaemic cardiac events and mortality from cardiovascular disease.
Dietary recommendations
Many national and international health organisations now give recommendations for
dietary prevention of CHD. They are summarised below:
Total fat should be reduced to 30% of energy

SFA intake should be reduced to below 10%

The intake of PUFA should be no more than 78% of energy


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MUFA intake should provide up to 15% of energy

Dietary cholesterol should be below 300 mg/day

Intake of complex carbohydrates and dietary fibre should be increased.

The traditional Mediterranean diet provides an excellent example of how to convert


these guidelines into everyday life. The Mediterranean diet contains an abundance of
vegetable-derived products (including bread, grain, fruit and vegetables) and a lowto-moderate amount of animal products. Importantly, olive oil is the principle source
of fat and provides a high MUFA content.