Review shows how extra virgin olive oil transforms heart health

By Priyanjana Pramanik, MSc.Reviewed by Lauren HardakerJun 2 2025

New research suggests that extra virgin olive oil doesn’t just flavor your meals; it could help fight heart disease, reduce inflammation, and enhance vascular health, especially when paired with a Mediterranean diet.

Study: Exploring the Benefits of Extra Virgin Olive Oil on Cardiovascular Health Enhancement and Disease Prevention: A Systematic Review. Image credit: sebra/Shutterstock.com

New research suggests that extra virgin olive oil doesn’t just flavor your meals; it could help fight heart disease, reduce inflammation, and enhance vascular health, especially when paired with a Mediterranean diet. In a recent review article published in the journal Nutrients, researchers in Italy suggest that regularly consuming extra-virgin olive oil (EVOO) as part of the Mediterranean diet reduces the risk of cardiovascular disease (CVD).

These benefits may be due to its high polyphenol content. However, the strongest evidence comes from studies in people with established cardiovascular disease or those at high risk (i.e., secondary prevention), with less data available for healthy populations. Still, the strength and consistency of the evidence vary among studies and populations, and further studies are needed to confirm these findings.

Study limitations include small sample sizes in many trials, diverse olive oil formulations, and a focus on high-risk groups rather than the general population. The authors emphasize the need for large, multicenter clinical trials to clarify these effects.

Bioactive compounds

Olive oil, particularly EVOO, is a cornerstone of the Mediterranean diet and has been valued for its nutritional and cultural significance since the seventh century BC. EVOO is obtained from the fruit of Olea Europaea, native to the Mediterranean region. It is considered the highest quality form due to its minimal processing and rich content of beneficial compounds.

While over 98% of olive oil is composed of substances like triglycerides and fatty acids, the remaining small portion consists of compounds, including polyphenols such as Hydroxytyrosol (HYTY), Tyrosol (TY), and their derivatives, which possess strong antioxidant properties.

Graphical Abstract

EVOO for cardiac health

The composition of these polyphenols varies depending on factors like climate, olive variety, and processing methods. These compounds have garnered attention for their potential health benefits, particularly in reducing oxidative stress and inflammation, which are key contributors to cardiovascular disease (CVD), atherosclerosis, and certain cancers. In 2012, the European Food Safety Authority approved a health claim stating that olive oil polyphenols prevent oxidative damage to blood lipids, provided the oil contains 5 mg or more of HYTY or its derivatives per 20 g.

Given this background, the systematic review aimed to evaluate the effects of consuming olive oil on cardiovascular health, particularly by analyzing clinical trials that explored improvements in cardiac biomarkers and cardiovascular outcomes.

EVOO’s cardiovascular benefits

Studies show that EVOO, a key component in the Mediterranean diet, can significantly lower the risk of cardiovascular events like heart attacks and strokes, particularly in individuals with pre-existing CVD or high risk. EVOO enhances blood vessel function (e.g., flow-mediated dilation), increases nitric oxide availability, and reduces inflammatory markers, such as C-reactive protein (CRP) and interleukin-6 (IL-6). It also decreases oxidized low-density lipid (LDL) cholesterol, enhances high-density lipid (HDL) levels, and raises total antioxidant capacity.

These changes contribute to lower systolic blood pressure and improved ankle-brachial index (ABI), a measure of blood flow to the limbs. However, the review notes that these benefits are more consistently observed in high-polyphenol EVOO and may vary depending on the population studied.

Many reviewed trials focused on high-risk individuals, particularly in secondary prevention settings, which may limit the ability to apply to a broader population. Not all studies found statistically significant changes in every measured outcome, such as HDL cholesterol efflux, and some effects were modest.

Evidence from clinical trials

One clinical trial in Spain found that a Mediterranean diet rich in virgin olive oil (VOO) was more effective than a low-fat diet at reducing cardiovascular events over seven years. Other studies showed that a high olive oil intake of between 20 g and 30 g per day was linked to a lower risk of stroke and CVD.

Studies in Australian adults have shown that high-polyphenol olive oil significantly reduces systolic blood pressure and ox-LDL levels, particularly in individuals with abdominal obesity or high inflammation. EVOO also improved endothelial function, an early indicator of vascular health, in prediabetic and diabetic individuals.

Metabolic and molecular studies offer insights into how EVOO provides these benefits. One study showed that EVOO consumption altered genetic profiles that were involved in inflammation and heart health. Metabolomics data from another trial showed that specific metabolites in olive oil are inversely linked to CVD risk, but these metabolites were not significantly associated with type 2 diabetes.

In some trials, specific markers, such as HDL cholesterol efflux capacity, did not show statistically significant improvements, indicating variable effect size depending on the outcome measured. Additionally, the diversity of olive oil formulations and polyphenol concentrations across studies complicates direct comparison and highlights the need for product standardization in future research.

It is important to note that the Mediterranean diet as a whole, which includes many other healthy foods besides EVOO, may also contribute to the observed cardiovascular benefits.

Regular EVOO consumption, especially when rich in polyphenols, is strongly linked to cardiovascular protection through anti-inflammatory, antioxidant, and blood pressure-lowering effects. It offers a powerful, food-based primary and secondary heart disease prevention strategy.

Conclusions

This systematic review highlights the cardioprotective benefits of VOO, particularly EVOO, mainly in individuals with or at high risk of CVD. Over the past two decades, numerous studies have demonstrated that EVOO, rich in polyphenols and monounsaturated fats, improves CVD-associated biomarkers, such as inflammation, oxidative stress, lipid profiles, and blood pressure. EVOO also enhances endothelial function, reduces arterial stiffness, and lowers markers like CRP and oxidized LDL, preventing atherosclerosis and coronary heart disease.

Evidence suggests that daily EVOO intake (20–30 g) as part of the Mediterranean diet may significantly reduce the risk of cardiovascular events and improve HDL function. Its anti-inflammatory and antioxidant properties help regulate key physiological processes linked to CVD progression. However, the review emphasizes that some of these effects vary in magnitude and consistency across studies.

The authors recommend standardized EVOO product formulations with defined polyphenol concentrations to improve the reliability and applicability of future research. Emerging EVOO extraction and formulation technologies may enhance its health benefits through increased bioavailability.

Despite promising findings, the review emphasizes the need for more robust, multicenter clinical trials to confirm these effects across diverse populations. Incorporating EVOO into a healthy diet represents a practical and effective strategy to support cardiovascular health. Still, standardized product formulations and more straightforward consumption guidelines are essential for maximizing its therapeutic potential.

In summary, while EVOO is a highly promising component of heart-healthy diets, most clinical benefits have been observed in people at high cardiovascular risk, and the consistency of these benefits across the general population remains to be confirmed by future research.

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