Associations of Dietary Cholesterol or Egg Consumption With Incident Cardiovascular Disease and Mortality

Abstract

IMPORTANCE Cholesterol is a common nutrient in the human diet and eggs are a major source of dietary cholesterol. Whether dietary cholesterol or egg consumption is associated with cardiovascular disease (CVD) and mortality remains controversial. OBJECTIVE To determine the associations of dietary cholesterol or egg consumption with incident CVD and all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS Individual participant data were pooled from 6 prospective US cohorts using data collected between March 25, 1985, and August 31, 2016. Self-reported diet data were harmonized using a standardized protocol. EXPOSURES Dietary cholesterol (mg/day) or egg consumption (number/day). MAIN OUTCOMES AND MEASURES Hazard ratio (HR) and absolute risk difference (ARD) over the entire follow-up for incident CVD (composite of fatal and nonfatal coronary heart disease, stroke, heart failure, and other CVD deaths) and all-cause mortality, adjusting for demographic, socioeconomic, and behavioral factors. RESULTS This analysis included 29 615 participants (mean [SD] age, 51.6 [13.5] years at baseline) of whom 13 299 (44.9%) were men and 9204 (31.1%) were black. During a median follow-up of 17.5 years (interquartile range, 13.0-21.7; maximum, 31.3), there were 5400 incident CVD events and 6132 all-cause deaths. The associations of dietary cholesterol or egg consumption with incident CVD and all-cause mortality were monotonic (all P values for nonlinear terms, .19-.83). Each additional 300 mg of dietary cholesterol consumed per day was significantly associated with higher risk of incident CVD (adjusted HR, 1.17 [95% CI, 1.09-1.26]; adjusted ARD, 3.24% [95% CI, 1.39%-5.08%]) and all-cause mortality (adjusted HR, 1.18 [95% CI, 1.10-1.26]; adjusted ARD, 4.43% [95% CI, 2.51%-6.36%]). Each additional half an egg consumed per day was significantly associated with higher risk of incident CVD (adjusted HR, 1.06 [95% CI, 1.03-1.10]; adjusted ARD, 1.11% [95% CI, 0.32%-1.89%]) and all-cause mortality (adjusted HR, 1.08 [95% CI, 1.04-1.11]; adjusted ARD, 1.93% [95% CI, 1.10%-2.76%]). The associations between egg consumption and incident CVD (adjusted HR, 0.99 [95% CI, 0.93-1.05]; adjusted ARD, −0.47% [95% CI, −1.83% to 0.88%]) and all-cause mortality (adjusted HR, 1.03 [95% CI, 0.97-1.09]; adjusted ARD, 0.71% [95% CI, −0.85% to 2.28%]) were no longer significant after adjusting for dietary cholesterol consumption. CONCLUSIONS AND RELEVANCE Among US adults, higher consumption of dietary cholesterol or eggs was significantly associated with higher risk of incident CVD and all-cause mortality in a dose-response manner. These results should be considered in the development of dietary guidelines and updates.

Dietary choline is related to increased risk of acute myocardial infarction in patients with stable angina pectoris

“…Notably, these choline sources tend to have high cholesterol content (especially 288 eggs) [11] and intake should be limited according to current dietary guidelines in context of 289 general and cardiovascular health [11,52]. Additionally, eggs, processed and unprocessed meat 290 are also high in carnitine, a TMAO precursor, and sodium (processed meat) which are 291 associated with CVD risk via different pathways [53]. In contrast, a higher total choline intake 292 was associated with higher vegetable and fibre intake, which are inversely associated with CVD 293 risk [11].…”

“…Even the association between eggs, which contain a high amount of PC and SM, and CVD 299 remains controversial [53][54][55]. Further research is needed to explore the underlying 300 mechanisms for the association between fat-soluble choline forms, the food items contributing 301 to their intake and CVD risk.…”

Effects of substituting eggs for high-carbohydrate breakfast foods on the cardiometabolic risk-factor profile in adults at risk for type 2 diabetes mellitus

“…In multivariate models that adjusted for intakes of nutrients and diet quality, for every 0.5 egg/day increment in intake, there was a 6% higher rate of incident CVD and a 7% higher rate of all-cause mortality. Both associations lost significance after adjustments for dietary cholesterol, suggesting that the cholesterol content of eggs is responsible for the associations [40]. Notably, adjustment for CVD risk markers, including non-HDL-C and HDL-C, did not materially alter the point estimates for the associations of egg or cholesterol intakes with incident CVD or mortality.…”

“…Results from a recent pooled analysis of data from six US prospective cohort studies (29,615 participants) indicated that both higher dietary cholesterol intake and higher egg intake were associated with higher incident CVD and allcause mortality over a median follow-up period of 17.5 years [40]. In the analysis, median cholesterol intake was 241 mg/d (IQR 164, 350) and median egg intake was 0.14 eggs/day (IQL 0.07, 0.43).…”

Higher intake of cholesterol or eggs linked to increased risk of cardiovascular disease and death, finds study

“…The study pooled individual participant data from six prospective US cohorts looking at dietary intake and cardiovascular disease using data collected from 29 615 adults followed up for a median of 17.5 years between 1985 and 2016 1. The authors harmonised self reported diet data across the studies using a standardised protocol.…”