Is olive oil good for heart health?

Probably yes, as part of a Mediterranean diet and in place of butter and other solid fats. In the PREDIMED trial of 7447 Spanish adults at high cardiovascular risk, a Mediterranean diet with extra virgin olive oil cut major cardiovascular events by about 31% over 4.8 years, from 4.4% of people in the control group to 3.8%. Olive oil has never been tested on its own in a trial with heart attacks or strokes as the outcome. In two large US cohorts it did no better than other vegetable oils combined.

Unsettled. The randomized evidence is for a whole diet that included a lot of olive oil, and the evidence for olive oil itself is observational. A 2025 umbrella review of 17 systematic reviews found the direction consistent and judged the evidence low quality, with high heterogeneity and few randomized trials. Its authors call further randomized trials imperative.

What the trials found

The Mediterranean diet trials

PREDIMED is the trial behind most claims about olive oil and the heart. Its first report in 2013 was withdrawn because of problems with randomization, and the 2018 reanalysis of all participants gave a hazard ratio of 0.69, with a confidence interval from 0.53 to 0.91, for the arm given extra virgin olive oil. The arm given nuts did about as well, at 0.72. The oil came with dietary counseling, about a liter a week per family. What the trial tests is a diet with a bottle in it.

The 2019 Cochrane review rated one PREDIMED result as moderate quality: strokes fell from 24 to 14 per 1000 people, a hazard ratio of 0.60. Its effect on cardiovascular death, a hazard ratio of 0.81 with an interval from 0.50 to 1.32, was rated low quality and stays uncertain. Total mortality did not change.

CORDIOPREV followed 1002 people who already had coronary heart disease for 7 years. A Mediterranean diet lowered major cardiovascular events compared with a low-fat diet. In men, events occurred in 16.2% on the Mediterranean diet against 22.8% on the low-fat diet. In the 175 women no difference was found, and that small group may simply have been too few to show one.

What the cohorts show

Spontaneous intake tells a consistent story. A 2024 dose-response meta-analysis of 30 cohort articles with about 2.7 million people linked the highest olive oil intake to 15% lower cardiovascular disease and 23% lower cardiovascular death than the lowest. A separate 2024 pooling of 7 studies put the drop in cardiovascular death at 16%. In a 2022 meta-analysis of 13 cohorts, higher intake tracked with lower cardiovascular risk, with little or no further reduction beyond about 20 g a day. People who use a lot of olive oil tend to eat and live in the Mediterranean way, so none of this shows the oil is the cause.

The signal is clearer for stroke than for the heart itself. A 2014 meta-analysis found each extra 25 g a day linked to 26% lower stroke risk in cohorts, and the link with coronary heart disease did not reach significance.

Myth. Olive oil is not uniquely protective among cooking oils. In two US cohorts of 92,383 nurses and health professionals followed for 28 years, replacing butter, margarine, mayonnaise or dairy fat with olive oil was linked to lower mortality. When olive oil was compared with other vegetable oils combined, no significant difference was found. The gain in these data comes from what the oil replaces.

Blood markers barely move

A 2024 meta-analysis of 18 trials of a Mediterranean diet enriched with olive oil found triglycerides fell by only 2.4 mg/dL and no consistent effect on any other marker of cardiovascular health. The gap between those small marker changes and the fall in events is not explained. The effect on cholesterol has its own page.

Who should be careful

Olive oil is pure fat, and the cautions here are about calories. A meta-analysis of 11 trials lasting at least 12 weeks found diets enriched with olive oil reduced body weight by 2 lb (0.92 kg) against control diets, and in those trials the oil was swapped into the diet rather than poured on top of it. The FDA's qualified claim carries the same condition: the oil should not increase the total number of calories you eat in a day.

We found no evidence of drug interactions with culinary olive oil, and no studies of this outcome in children or in pregnancy. Missing data here says nothing either way about safety.

What expert bodies say

The US FDA allows only a qualified health claim, its weakest category, for oils high in oleic acid at about 1.5 tablespoons, or 20 g, a day, replacing fats higher in saturated fat. It calls the evidence supportive but not conclusive, and the claim covers oils with at least 70% oleic acid, which ordinary olive oil often falls below. The EU did not authorize the label claim that olive oil promotes heart health. That decision means the dossier fell short when assessed, which is different from evidence of no effect.

The American Heart Association concludes strongly that replacing saturated fat with unsaturated fats, especially polyunsaturated ones, lowers cardiovascular disease, within a pattern such as DASH or the Mediterranean diet. Olive oil is mostly monounsaturated, so the advisory's emphasis sits slightly away from it.

How we searched

What would change this answer

• A randomized trial of olive oil alone, against other unsaturated oils, with heart attacks and strokes as the outcome. We found none registered on ClinicalTrials.gov as of 6 October 2026.
• More women in trials of people who already have heart disease. CORDIOPREV had 175.
• Better quality trials of any kind. The umbrella review's verdict of low quality evidence is the main reason this page does not say proven.

More on olive oil itself, from its fats to how it compares with other oils, is on the olive oil page.

Sources

1. ev-oohd-01 · Observational data · systematic review and dose-response meta-analysis of prospective cohort studies, PROSPERO CRD42023419001 · n = 2 710 351
   Higher olive oil intake was linked with a reduced risk of CVD incidence (RR: 0.85; 95% CI: 0.77, 0.93), CHD incidence (RR: 0.85; 95% CI: 0.72, 0.99), CVD mortality (RR: 0.77; 95% CI: 0.67, 0.88), and all-cause mortality (RR: 0.85; 95% CI: 0.81, 0.89).
   
   Who: Adults in prospective cohort studies, 30 articles
   Effect: highest vs lowest intake: CVD incidence RR 0.85 (95% CI 0.77 to 0.93); CHD incidence RR 0.85 (0.72 to 0.99); CVD mortality RR 0.77 (0.67 to 0.88); per 10 g/day: CVD incidence -7%, stroke -5%, CVD mortality -8%
   Certainty: Synthesis of observational data: association, not evidence of cause; olive oil in cohorts is a marker of a Mediterranean lifestyle. Nonlinear: benefit up to ~18 g/day, then a plateau.
   Food & Function, 2024 · checked 2026-10-06 · we read the abstract
2. ev-oohd-02 · Observational data · systematic review and meta-analysis of prospective cohort studies · n = 13 cohorts
   Non-linear associations of olive oil intake with CVD and all-cause mortality were also identified (both p for non-linearity < 0.001), with little additional or no risk reduction observed beyond the consumption of approximately 20 g/days.
   
   Who: Participants of 13 prospective cohort studies
   Effect: higher vs lower: CVD RR 0.85 (95% CI 0.77 to 0.93); per 5 g/day: RR 0.96 (0.93 to 0.99); non-linear, plateau near 20 g/day
   Certainty: Observational data. The plateau of ~20 g/day (about 1.5 tbsp) is a useful benchmark that more oil does not mean more benefit, while calories keep rising.
   Frontiers in Nutrition, 2022 · checked 2026-10-06 · we read the abstract
3. ev-oohd-03 · Observational data · systematic review and meta-analysis of observational studies · n = 7 studies
   Our results showed an association between OO consumption and reduction in all-cause mortality (HR: 0.85; 95% CI: 0.80-0.91), cardiovascular mortality (HR: 0.84; 95% CI: 0.76-0.93) and cancer mortality (HR: 0.89; 95% CI: 0.86-0.93).
   
   Who: Adult population in 14 studies of the systematic review, 7 in the meta-analysis
   Effect: cardiovascular mortality HR 0.84 (95% CI 0.76 to 0.93); all-cause mortality HR 0.85 (0.80 to 0.91)
   Certainty: Mostly cohorts; overlap in composition with 38568797.
   Food Funct, 2024 · checked 2026-10-06 · we read the abstract
4. ev-oohd-04 · Observational data · meta-analysis of case-control, prospective cohort studies and one randomized controlled trial · n = 38,673
   In cohort studies, the random-effects model assessing stroke showed a RR of 0.74 (95% CI 0.60, 0.92).
   
   Who: Case-control, cohort and intervention studies; CHD 101,460 and stroke 38,673 participants
   Effect: per 25 g/day, cohorts: CHD RR 0.96 (95% CI 0.78 to 1.18); stroke RR 0.74 (0.60 to 0.92); CHD and stroke combined RR 0.82 (0.70 to 0.96)
   Certainty: Meta-analysis of mixed designs; the stroke number is from a cohort subgroup, so level C. Signs of small-study effect (Egger P = 0.06); heterogeneity for CHD.
   Br J Nutr, 2014 · checked 2026-10-06 · we read the abstract
5. ev-oohd-05 · Meta-analysis or systematic review · Cochrane systematic review and meta-analysis of randomized controlled trials · n = 7447
   There was, however, a reduction in the number of strokes with the PREDIMED intervention (HR 0.60, 95% CI 0.45 to 0.80), a decrease from 24/1000 to 14/1000 (95% CI 11 to 19), moderate-quality evidence).
   
   Who: PREDIMED participants within 30 RCTs of Mediterranean-style diets
   Effect: stroke HR 0.60 (95% CI 0.45 to 0.80), 24/1000 to 14/1000, moderate quality; CVD mortality HR 0.81 (0.50 to 1.32), low quality; total mortality HR 1.0 (0.81 to 1.24)
   Certainty: The intervention is diet plus oil or nuts, not oil alone. Cochrane rates quality as low-moderate.
   Cochrane Database Syst Rev, 2019 · checked 2026-10-06 · we read the abstract
6. ev-oohd-06 · Observational data · umbrella review of systematic reviews, PROSPERO CRD42022357290 · n = 17 reviews
   Given the high heterogeneity and low quality of evidence, further studies involving randomized trials are imperative.
   
   Who: Adults in 17 systematic reviews of randomized trials and observational studies
   Effect: beneficial association with cardiovascular disease; quality low, heterogeneity high, wide confidence intervals
   Certainty: This is the main caveat for the page: the direction is consistent, but most data are observational, hence level C, not A.
   Nutr Rev, 2025 · checked 2026-10-06 · we read the abstract
7. ev-oohd-07 · Randomized controlled trial(s) · multicentre randomized trial, ISRCTN35739639, republished 2018 after protocol deviations · n = 7447
   In the intention-to-treat analysis including all the participants and adjusting for baseline characteristics and propensity scores, the hazard ratio was 0.69 (95% confidence interval [CI], 0.53 to 0.91) for a Mediterranean diet with extra-virgin olive oil and 0.72 (95% CI, 0.54 to 0.95) for a Mediterranean diet with nuts, as compared with the control diet.
   
   Who: 7447 participants, 55 to 80 years, 57% women, high cardiovascular risk, no cardiovascular disease at enrollment
   Effect: major cardiovascular events 3.8% EVOO arm vs 4.4% control; HR 0.69 (95% CI 0.53 to 0.91); median follow-up 4.8 years
   Certainty: The original 2013 publication was retracted because of randomization violations; the 2018 reanalysis gave similar estimates. The oil (about 1 L per week per family) was given together with dietary counseling.
   New England Journal of Medicine, 2018 · checked 2026-10-06 · we read the abstract
8. ev-oohd-08 · Randomized controlled trial(s) · single-center randomized clinical trial, NCT00924937 · n = 1002
   These effects were more evident in men, with primary endpoints occurring in 67 (16·2%) of 414 men in the Mediterranean diet group versus 94 (22·8%) of 413 men in the low-fat diet group (multiadjusted HR 0·669 [95% CI 0·489-0·915], log-rank p=0·013), than in 175 women for whom no difference was found between groups.
   
   Who: Patients with established coronary heart disease, aged 20-75 years, 82.5% men
   Effect: men: events 16.2% vs 22.8%, multiadjusted HR 0.669 (95% CI 0.489 to 0.915); overall HR 0.719 to 0.753 across models; no difference in 175 women
   Certainty: Oil as part of a Mediterranean diet, not a separate intervention. Only 175 women, so the absence of an effect in them may be a lack of power.
   Lancet, 2022 · checked 2026-10-06 · we read the abstract
9. ev-oohd-09 · Observational data · two prospective cohort studies, Cox proportional-hazards models · n = 92,383
   No significant associations were observed when olive oil was compared with other vegetable oils combined.
   
   Who: 60,582 women (Nurses' Health Study) and 31,801 men (Health Professionals Follow-up Study)
   Effect: highest intake (>7 g/day) vs never: CVD mortality HR 0.81 (95% CI 0.75 to 0.87); replacing 10 g/day of other fats: 8% to 34% lower mortality; no significant difference vs other vegetable oils
   Certainty: Key nuance for the "olive oil is special" myth: the benefit comes from replacing solid fats, not from the oil itself.
   J Am Coll Cardiol, 2022 · checked 2026-10-06 · we read the abstract
10. ev-oohd-10 · Meta-analysis or systematic review · systematic review and meta-analysis of randomized controlled trials, CRD42023424641 · n = 18 trials
    MedDiet enriched with olive oil showed no consistent effects on any of the reported markers of cardiovascular health except on TG.
    
    Who: Participants of 18 clinical trials of Mediterranean diet enriched with olive oil
    Effect: TG WMD -2.40 mg/dL (95% CI -4.533 to -0.262); no consistent effect on lipids, glycemia, blood pressure, anthropometry
    Certainty: Strong heterogeneity; risk of selective reporting. The gap between markers and events is an open question.
    Eur J Nutr, 2024 · checked 2026-10-06 · we read the abstract
11. ev-oohd-11 · Meta-analysis or systematic review · systematic review and meta-analysis of randomized controlled trials · n = 11 studies
    A diet enriched in olive oil reduced weight more than control diet: -0.92 kg, 95% CI (-1.16, -0.67), p heterogeneity = 0.1; decreased waist circumference in -0.60 cm, 95% CI (-1.17, -0.04), p heterogeneity = 0.6; and diminished BMI in -0.90, 95% CI (-0.91, -0.88), p heterogeneity < 0.001.
    
    Who: Adults without previous cardiovascular events in RCTs of at least 12 weeks
    Effect: weight -2 lb (95% CI -2.6 to -1.5; metric: -0.92 kg, -1.16 to -0.67); waist -0.24 in (-0.46 to -0.02; metric: -0.60 cm, -1.17 to -0.04); BMI -0.90
    Certainty: The oil was introduced within the diet (as a replacement), not on top of it; capsules gave no effect. 1 tbsp ≈ 120 calories, so oil added on top adds energy (see the FDA condition, ev-oohd-12).
    Rev Esp Salud Publica, 2018 · checked 2026-10-06 · we read the abstract
12. ev-oohd-12 · Position of an expert body · FDA qualified health claim, enforcement discretion, oleic acid and coronary heart disease, 2018 · n = —
    To achieve this possible benefit, oleic acid-containing oils should not increase the total number of calories you eat in a day.
    
    Who: food labeling in the United States
    Effect: about 1.5 tablespoons (20 g) a day replacing fats higher in saturated fat; evidence supportive but not conclusive; no increase in total daily calories
    Certainty: A qualified claim is the weakest level in the US; it applies to oils with ≥70% oleic acid, regular olive oil is often below this threshold.
    FDA, Constituent Update: FDA completes review of qualified health claim petition for oleic acid and the risk of coronary heart disease, 2018 · checked 2026-10-06 · we read the page
13. ev-oohd-13 · Position of an expert body · EU Register on nutrition and health claims, entry POL-HC-7679, snapshot of 2026-09-21 · n = —
    POL-HC-7679 Olive Oil Olive Oil promotes your heart health Non-authorised
    
    Who: food labeling in the European Union
    Effect: status Non-authorized for the substance Olive Oil and the claim Olive Oil promotes your heart health
    Certainty: Non-authorized means the dossier fell short at the time of assessment, not that there is no effect. Only the claim about polyphenols and lipid oxidation (POL-HC-6431) is authorized.
    EU Register on nutrition and health claims, claim POL-HC-7679, snapshot 2026-09-21 · checked 2026-10-06 · we read the row
14. ev-oohd-14 · Position of an expert body · presidential advisory, American Heart Association · n = —
    Taking into consideration the totality of the scientific evidence, satisfying rigorous criteria for causality, we conclude strongly that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD.
    
    Who: general population, AHA presidential advisory
    Effect: RCTs replacing saturated fat with polyunsaturated vegetable oil reduced CVD by about 30%
    Certainty: AHA emphasizes polyunsaturated fats more than monounsaturated (the basis of olive oil): this is consistent with 35027106 (no advantage over other vegetable oils).
    Circulation, 2017 · checked 2026-10-06 · we read the abstract