Egg consumption and risk of cardiovascular disease: three large prospective US cohort studies, systematic review, and updated meta-analysis

Abstract

Objective To evaluate the association between egg intake and cardiovascular disease risk among women and men in the United States, and to conduct a meta-analysis of prospective cohort studies. Design Prospective cohort study, and a systematic review and meta-analysis of prospective cohort studies. Setting Nurses’ Health Study (NHS, 1980-2012), NHS II (1991-2013), Health Professionals’ Follow-Up Study (HPFS, 1986-2012). Participants Cohort analyses included 83 349 women from NHS, 90 214 women from NHS II, and 42 055 men from HPFS who were free of cardiovascular disease, type 2 diabetes, and cancer at baseline. Main outcome measures Incident cardiovascular disease, which included non-fatal myocardial infarction, fatal coronary heart disease, and stroke. Results Over up to 32 years of follow-up (>5.54 million person years), 14 806 participants with incident cardiovascular disease were identified in the three cohorts. Participants with a higher egg intake had a higher body mass index, were less likely to be treated with statins, and consumed more red meats. Most people consumed between one and less than five eggs per week. In the pooled multivariable analysis, consumption of at least one egg per day was not associated with incident cardiovascular disease risk after adjustment for updated lifestyle and dietary factors associated with egg intake (hazard ratio for at least one egg per day v less than one egg per month 0.93, 95% confidence interval 0.82 to 1.05). In the updated meta-analysis of prospective cohort studies (33 risk estimates, 1 720 108 participants, 139 195 cardiovascular disease events), an increase of one egg per day was not associated with cardiovascular disease risk (pooled relative risk 0.98, 95% confidence interval 0.93 to 1.03, I 2 =62.3%). Results were similar for coronary heart disease (21 risk estimates, 1 411 261 participants, 59 713 coronary heart disease events; 0.96, 0.91 to 1.03, I 2 =38.2%), and stroke (22 risk estimates, 1 059 315 participants, 53 617 stroke events; 0.99, 0.91 to 1.07, I 2 =71.5%). In analyses stratified by geographical location (P for interaction=0.07), no association was found between egg consumption and cardiovascular disease risk among US cohorts (1.01, 0.96 to 1.06, I 2 =30.8%) or European cohorts (1.05, 0.92 to 1.19, I 2 =64.7%), but an inverse association was seen in Asian cohorts (0.92, 0.85 to 0.99, I 2 =44.8%). Conclusions Results from the three cohorts and from the updated meta-analysis show that moderate egg consumption (up to one egg per day) is not associated with cardiovascular disease risk overall, and is associated with potentially lower cardiovascular disease risk in Asian populations. Systematic review registration PROSPERO CRD42019129650.

Egg Consumption and Stroke Risk: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies

“…Two cohort studies were identified by a manual search ( 5 , 15 ). Ultimately, 16 articles involving 24 cohort studies were included ( 4 – 9 , 12 , 13 , 15 – 22 ).…”

“…Limited data on egg intake pattern were reported in the original studies. Most studies reported whole-egg intake or eggs consumed as components of recipes (6,8,9,12,13,16,19,21,22), including fried, boiled, poached, deviled, or egg salad, but baked dishes (such as custards and puddings) were not included (6,19). Other studies did not report the egg intake pattern (4,5,7,15,17,18,20).…”

“…The fairly low-calorie egg is a rich source of high-quality protein, folate, choline, riboflavin, selenium, and many vitamins but also has a high dietary cholesterol level. Epidemiological studies focusing on the association between egg consumption and stroke have produced inconsistent results (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Five studies showed an increased risk of stroke (5,10,12,16,18,22), although the results were not statistically significant, some indicated a significant or non-significant inverse relationship (6-8, 17, 20, 21), and only one study revealed no association (14).…”

Training the translational workforce: Expanding beyond translational research to include translational science

“…7,8 In contrast, scientific misinformation (e.g., regarding vaccination and stem cell therapies) travels at Internet speed. [9][10][11][12] And still other health-related recommendations, such as whether to take aspirin for primary prevention of cardiovascular disease 13,14 or whether eating eggs 15,16 or red meat is harmful, seem to be cyclical, engendering confusion at best and mistrust of science at worst. 17 As Arthur D. Little stated nearly 100 years ago, "In the past the world suffered grievously from lack of knowledge; today it suffers from its rejection or misapplication."…”

Egg consumption and cardiovascular disease

“…The residue of this hypothesis has been the impetus for a large body of research, including most recently, the substantial contribution by Drouin-Chartier and colleagues in a linked article in The BMJ (doi:10.1136/bmj.m513). 4…”