From the Guidelines
For CAD patients, the healthiest alternative to butter is olive oil, due to its high content of monounsaturated fats that can help improve cholesterol levels and reduce the risk of cardiovascular events, as shown in a recent study published in 2022 1. The study found that consuming olive oil, rich in monounsaturated fats, is associated with a lower risk of cardiovascular disease, and that replacing saturated fats with unsaturated fats, such as those found in olive oil, can reduce the incidence of coronary heart disease by 24% 1. In contrast, butter consumption has been found to have a neutral association with the risk of coronary heart disease, but it is still recommended to limit its intake due to its high saturated fat content 1. Other healthier alternatives to butter include plant-based oils, such as avocado oil, and plant sterol-enriched margarines, which are lower in saturated fat and contain heart-healthy fats that can help improve cholesterol levels. Additionally, incorporating other heart-healthy dietary choices, such as increasing fiber intake, reducing sodium, and consuming more fruits, vegetables, and whole grains, can provide greater cardiovascular benefits than focusing on butter alternatives alone, as recommended by the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease 2. Some key points to consider when choosing a healthier butter alternative include:
- Limiting saturated fat intake to less than 6% of total caloric intake, as recommended by the AHA 2
- Replacing saturated fats with unsaturated fats, such as those found in olive oil, to reduce the incidence of coronary heart disease 1
- Incorporating other heart-healthy dietary choices, such as increasing fiber intake and consuming more fruits and vegetables, to provide greater cardiovascular benefits 2.
From the Research
Healthiest Butter for CAD Patients
There are no direct studies on the healthiest butter for CAD patients. However, some studies provide insights into the relationship between butter, plant-based oils, and cardiovascular health:
- A study published in 2025 3 found that higher intake of butter was associated with increased mortality, while higher plant-based oils intake was associated with lower mortality.
- The same study found that substituting butter with plant-based oils may confer substantial benefits for preventing premature deaths.
- Another study published in 2025 4 found that elevated remnant cholesterol and LDL cholesterol both increase the risk of coronary artery disease (CAD) and peripheral artery disease (PAD).
- A study published in 2000 5 established the classical risk factor concept for coronary heart disease (CAD), which includes raised serum total cholesterol, high blood pressure, and smoking.
- A study published in 2013 6 found that the proportion of patients achieving current lipid goals in two high-risk cohorts of CAD patients was low and had only slightly improved.
- A study published in 1988 7 found that low levels of high-density lipoprotein (HDL) cholesterol are as much a risk factor for CAD as high LDL cholesterol.
Key Findings
- Higher intake of butter is associated with increased mortality, while higher plant-based oils intake is associated with lower mortality 3.
- Substituting butter with plant-based oils may confer substantial benefits for preventing premature deaths 3.
- Elevated remnant cholesterol and LDL cholesterol both increase the risk of CAD and PAD 4.
- Raised serum total cholesterol, high blood pressure, and smoking are classical risk factors for CAD 5.