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Olive oil intake and risk of cardiovascular disease and mortality in the PREDIMED Study

Marta Guasch-Ferré12, Frank B Hu3, Miguel A Martínez-González24, Montserrat Fitó5, Mònica Bulló12, Ramon Estruch26, Emilio Ros27, Dolores Corella28, Javier Recondo29, Enrique Gómez-Gracia102, Miquel Fiol11, José Lapetra122, Lluís Serra-Majem132, Miguel A Muñoz14, Xavier Pintó152, Rosa M Lamuela-Raventós16, Josep Basora12, Pilar Buil-Cosiales1724, José V Sorlí28, Valentina Ruiz-Gutiérrez182, J Alfredo Martínez19 and Jordi Salas-Salvadó12*

Author Affiliations

1 Human Nutrition Unit, University Hospital of Sant Joan de Reus, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, C/ Sant Llorenç 21, Reus, 43201, Spain

2 CIBERobn, Institute of Health Carlos III, Madrid, Spain

3 Department of Nutrition, Harvard School of Public Health, Boston, MA, USA

4 Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain

5 Cardiovascular Risk and Nutrition (Regicor Study Group), Hospital del Mar Medical Research Institute, Barcelona Biomedical Research Park, Barcelona, Spain

6 Department of Internal Medicine, August Pi i Sunyer Institute of Biomedical Research (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain

7 Lipid Clinic, Endocrinology and Nutrition Service, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain

8 Department of Preventive Medicine, University of Valencia, Valencia, Spain

9 Department of Cardiology, University Hospital Araba, Vitoria, Spain

10 Department of Preventive Medicine, University of Malaga, Malaga, Spain

11 Institute of Health Sciences, University of Balearic Islands and Son Espases Hospital, Palma de Mallorca, Spain

12 Department of Family Medicine, Primary Care Division of Sevilla, San Pablo Health Center, Sevilla, Spain

13 Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain

14 Primary Care Division, Catalan Institute of Health, IDiap-Jordi Gol, Barcelona, Spain

15 Lipid and Vascular Risk Unit, Department of Internal Medicine, Bellvitge University Hospital, Hospitalet de Llobregat, FIPEC, Barcelona, Spain

16 Nutrition and Food Safety Research Institute, Faculty of Pharmacy, University of Barcelona, Barcelona, Spain

17 Primary care, Servicio Navarro de Salud Osadunbidea, Pamplona, Spain

18 La Grasa Institute, Spanish National Research Council, Sevilla, Spain

19 Department of Food Science Nutrition, Physiology and Toxicology, University of Navarra, Pamplona, Spain

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BMC Medicine 2014, 12:78  doi:10.1186/1741-7015-12-78

Published: 13 May 2014



It is unknown whether individuals at high cardiovascular risk sustain a benefit in cardiovascular disease from increased olive oil consumption. The aim was to assess the association between total olive oil intake, its varieties (extra virgin and common olive oil) and the risk of cardiovascular disease and mortality in a Mediterranean population at high cardiovascular risk.


We included 7,216 men and women at high cardiovascular risk, aged 55 to 80 years, from the PREvención con DIeta MEDiterránea (PREDIMED) study, a multicenter, randomized, controlled, clinical trial. Participants were randomized to one of three interventions: Mediterranean Diets supplemented with nuts or extra-virgin olive oil, or a control low-fat diet. The present analysis was conducted as an observational prospective cohort study. The median follow-up was 4.8 years. Cardiovascular disease (stroke, myocardial infarction and cardiovascular death) and mortality were ascertained by medical records and National Death Index. Olive oil consumption was evaluated with validated food frequency questionnaires. Multivariate Cox proportional hazards and generalized estimating equations were used to assess the association between baseline and yearly repeated measurements of olive oil intake, cardiovascular disease and mortality.


During follow-up, 277 cardiovascular events and 323 deaths occurred. Participants in the highest energy-adjusted tertile of baseline total olive oil and extra-virgin olive oil consumption had 35% (HR: 0.65; 95% CI: 0.47 to 0.89) and 39% (HR: 0.61; 95% CI: 0.44 to 0.85) cardiovascular disease risk reduction, respectively, compared to the reference. Higher baseline total olive oil consumption was associated with 48% (HR: 0.52; 95% CI: 0.29 to 0.93) reduced risk of cardiovascular mortality. For each 10 g/d increase in extra-virgin olive oil consumption, cardiovascular disease and mortality risk decreased by 10% and 7%, respectively. No significant associations were found for cancer and all-cause mortality. The associations between cardiovascular events and extra virgin olive oil intake were significant in the Mediterranean diet intervention groups and not in the control group.


Olive oil consumption, specifically the extra-virgin variety, is associated with reduced risks of cardiovascular disease and mortality in individuals at high cardiovascular risk.

Trial registration

This study was registered at ( International Standard Randomized Controlled Trial Number (ISRCTN): 35739639. Registration date: 5 October 2005.

Olive oil; Cardiovascular; Mortality; Mediterranean Diet; PREDIMED