Coconut Oil and Cardiovascular Disease Risk

This narrative review examines the cardiovascular health impacts of coconut oil, drawing from current peer-reviewed literature. Despite the absence of randomized controlled trials (RCTs) or prospective cohort studies directly linking coconut oil with cardiovascular disease (CVD), some evidence suggests that coconut oil may have less adverse effects on total and LDL-cholesterol compared to butter, though not as beneficial as cis-unsaturated vegetable oils like safflower, sunflower, or canola oil.
A network meta-analysis of 54 RCTs indicated that replacing butter with coconut oil can reduce LDL-C by 0.23 mmol/L, total cholesterol by 0.18 mmol/L, and improve HDL-C by 0.04 mmol/L. Conversely, higher intake of coconut oil increased plasma LDL-C by 0.27 mmol/L and HDL-C by 0.10 mmol/L compared to non-tropical vegetable oils. 
Virgin coconut oil, compared to refined variants, contains higher amounts of phenolic acids, flavonoids, and vitamins A and E, potentially offering more health benefits. However, high intake of saturated fatty acids (SFA), particularly lauric acid predominant in coconut oil, has been shown to increase cholesterol levels. Substitution studies demonstrated that replacing carbohydrates with lauric acid increased total cholesterol, LDL-C, and HDL-C, while reducing triacylglycerols.
The review highlights the need for further research to determine the long-term effects of coconut oil on cardiovascular health. Public health nutrition policies promoting the reduction of SFA intake and the substitution with healthier fats could significantly impact cardiovascular health.