Is butter consumption beneficial or harmful to cardiovascular health, particularly for adults with a history of heart disease or high cholesterol?

Butter: Relatively Neutral for Cardiovascular Health, But Plant-Based Oils Are Superior

Butter consumption appears relatively neutral for cardiovascular disease, stroke, and total mortality, but you should preferentially use plant-based oils—particularly olive, canola, and soybean oils—which demonstrate clear mortality benefits and superior cardiovascular outcomes. 1

Cardiovascular Disease and Mortality Outcomes

Butter's Neutral Profile

• Butter consumption shows no significant association with incident coronary heart disease, stroke, or total mortality in large pooled European cohorts 1
• A 2016 meta-analysis of 636,151 participants found butter was only weakly associated with all-cause mortality (RR = 1.01 per tablespoon daily) and showed no significant cardiovascular disease association 2
• However, the most recent 2025 study of 221,054 US adults over 33 years found the highest butter intake was associated with 15% higher total mortality (HR 1.15) and 12% higher cancer mortality (HR 1.12) compared to lowest intake 3

Plant-Based Oils Show Clear Benefits

• The 2025 study demonstrates that highest plant-based oil intake was associated with 16% lower total mortality (HR 0.84), 11% lower cancer mortality (HR 0.89), and 6% lower CVD mortality (HR 0.94) 3
• The PREDIMED randomized trial showed extra-virgin olive oil with Mediterranean diet reduced stroke, MI, or death by 30% 1
• Olive oil consumption is associated with 35% lower CVD risk in European cohorts 1

Lipid Effects: A Critical Consideration

Butter Raises LDL Cholesterol

• Butter significantly increases both total cholesterol and LDL cholesterol compared to olive oil (P < 0.05) 4
• In a randomized trial, butter increased LDL-C by 0.42 mmol/L compared to coconut oil and 0.38 mmol/L compared to olive oil 5
• Butter does increase HDL cholesterol modestly compared to habitual diet 4, 6

Replacement Strategy Yields Maximum Benefit

• Substituting 10g daily of butter with plant-based oils reduces total mortality by 17% and cancer mortality by 17% 3
• Replacing saturated fats with omega-6 polyunsaturated fatty acids (from vegetable oils) reduces CHD incidence by 24-29% in adequate controlled trials 1

Diabetes Risk

• Butter appears neutral or possibly protective for diabetes risk (RR 0.96), though this may reflect reverse causation bias among non-consumers 1, 2
• Olive oil shows more consistent benefits, with 10g daily consumption associated with 9% reduced diabetes risk 1

Weight Management Concerns

• Butter consumption is associated with modestly greater long-term weight gain compared to other fats 1
• This adverse effect on weight regulation should be considered for patients with obesity or metabolic syndrome 1

Clinical Recommendation Algorithm

For patients with high cholesterol or cardiovascular disease history:

• Minimize butter consumption given LDL-raising effects 1, 4
• Replace with extra-virgin olive oil, canola oil, or soybean oil 1, 3

For normocholesterolemic healthy adults:

• Moderate butter intake (up to 1 tablespoon daily) appears acceptable but not optimal 4
• Preferentially use plant-based oils to maximize mortality reduction 3

For all populations:

• The 2022 European guidelines rate butter as having "insufficient/controversial" evidence with neutral risk, while olive oil and vegetable oils rich in linoleic acid receive high consistency ratings for reduced atherosclerosis risk 1

Important Caveats

• The evidence suggests butter is "at worst, neutral" for cardiometabolic health, but this does not mean it is optimal 1
• The absence of strong harmful associations does not justify recommending butter over clearly beneficial alternatives like olive oil 1
• Publication bias may exist, as surprisingly few studies report on butter-cardiovascular relationships 1
• The most recent and highest-quality evidence (2025 cohort with 33-year follow-up) shows clear mortality benefits favoring plant-based oils over butter 3