OLIVE OILS AND HEALTH 134 for every 10 g/day consumed. In the PREDIMED pilot study, resistance to insulin at 3 months lowered in participants with Mediterranean diet supplemented with EVOO when compared to the control. When data from the whole PREDIMED cohort were evaluated, a Mediterranean diet supplemented with EVOO promoted a 40% reduction in diabetes risk. Such a finding was attributed to the antioxidant and anti-inflammatory effects of both the EVOO and the Mediterranean diet. - Effects on other vascular risk factors The effects of EVOO on other vascular risk factors such as overweight/obesity and metabolic syndrome will be addressed in other chapters of this publication. 10.3. Olive oil, atherosclerosis, and cardiovascular disease Given that olive oil is one of the pillars of the Mediterranean diet, it is difficult to evaluate its separate effects in long-term studies. There is, however, evidence supporting an inverse association between olive oil consumption per se and cardiovascular disease. The endothelial function is the first aspect to be altered in response to vascular risk factors. The protective effects of olive oil can be observed even in the initial steps of cardiovascular disease. Results from a meta-analysis showed significant improvements in endothelial function associated with an olive oil consumption from 1 to 50 mL/day. Such effects can also be observed in the subsequent stages of arteriosclerosis progression including the final one –thrombosis. Due to this, the results of all performed studies reflect, to a greater or lesser extent, the protective effects of olive oil consumption on cardiovascular disease. In the Spanish EPIC study cohort, after a 10-year follow-up total olive oil consumption was associated with an almost 25% reduction in cardiovascular complications and less all-cause mortality. In this study, greater benefits were obtained when EVOO was consumed instead of common olive oil. Within the frame of the EPICOR (long tErm follow-up of antithrombotic management Patterns In acute CORonary syndrome) study a follow-up of 30000 Italian women for 7.8 years was performed. Results showed a 44% reduction in coronary heart disease among the highest quartile of olive oil consumption compared to the lowest quartile. The PREDIMED study, to date one of the largest nutritional intervention studies performed in Europe, included 7447 individuals at high vascular risk who were followed-up a mean of 4.8 years. The conclusion was that a Med-
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