Eggs and Heart Disease: The Debate May Not Be Over

New study findings published in JAMA suggest there may be a significant dose-response relationship between higher dietary cholesterol intake and incident cardiovascular disease (CVD) and all-cause mortality, adding to a decades-long debate over the effects of dietary cholesterol consumption on cardiovascular and mortality risks.

These findings may have implications for future nutritional guidelines and updates, the authors of the study wrote, noting that the 2015-2020 Dietary Guidelines for Americans suggest that concern for overconsumption of dietary cholesterol is not warranted.

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Researchers arrived at this conclusion following an analysis of participant data from 6 prospective US cohorts (N = 29,615), including data on daily dietary cholesterol or egg consumption. Median follow-up lasted 17.5 years.

The main outcomes were all-cause mortality and incident CVD, which was defined as a composite of fatal and nonfatal coronary heart disease, stroke, heart failure, and other CVD deaths.

A total of 5400 incident CVD events and 6132 all-cause deaths occurred over the follow-up period. Ultimately, the researchers observed monotonic associations of dietary cholesterol or egg consumption with incident CVD and all-cause mortality, particularly among individuals whose dietary cholesterol consumption was significantly higher than the global average.

In the United States, mean dietary cholesterol consumption was 290 mg per day compared with a global mean of 228 mg per day, the researchers wrote.

Notably, the risks of incident CVD (adjusted hazard ratio [HR] 1.17) and all-cause mortality (adjusted HR 1.18) were found to increase significantly with each additional 300 mg of dietary cholesterol consumed per day.

In terms of quantities of egg consumed, each additional half an egg consumed was found to be significantly associated with an increased CVD risk (adjusted HR 1.06) and mortality risk (adjusted HR 1.08). However, following adjustment for dietary cholesterol consumption, the associations between egg consumption and incident CVD (adjusted HR 0.99) and all-cause mortality (HR 1.03) no longer reached significance.

—Christina Vogt

Reference:

Zhong VW, Van Horn L, Cornelis MC, et al. Associations of dietary cholesterol or egg consumption with incident cardiovascular disease and mortality. JAMA. 2019;321(11):1081-1095. doi:10.1001/jama.2019.1572.