After Continued Debate, Dietary Cholesterol Linked to Significant Increase in CVD

Among adults in the United States, higher consumption of dietary cholesterol or eggs is significantly associated with a higher risk for incident cardiovascular disease (CVD) and all-cause mortality in a dose-response manner, according to a study published in JAMA.¹

The relationship between dietary cholesterol consumption and CVD and mortality continues to be debated after years of research.² Eggs are a major source of dietary cholesterol, with a large egg containing approximately 186 mg of cholesterol³; reported associations of the relationship between egg consumption and CVD and mortality have been inconsistent.^4-9

By pooling individual participant data collected between March 25, 1985, and August 31, 2016, from 6 US prospective cohort studies, researchers sought to determine the associations of dietary cholesterol or egg consumption with incident CVD and all-cause mortality.¹ Among the 29,615 participants during a median follow-up of 17.5 years, there were 5400 incident CVD events and 6132 all-cause deaths.

Each additional 300 mg of dietary cholesterol consumed per day was significantly associated with a higher risk for incident CVD and all-cause mortality, as was each additional half an egg consumed per day.

However, the associations between egg consumption and incident CVD and all-cause mortality were no longer significant after adjusting for dietary cholesterol consumption. It is important to note that among other limitations, these study findings are observational and cannot establish causality.

“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,” concluded the authors.¹ In addition, “these results should be considered in the development of dietary guidelines and updates.”

Disclosures: Drs Wilkins and Mentz report the receipt of consulting fees and/or research report from the pharmaceutical industry. For a full list of disclosures, please see the full text of the study.

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References

1. 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.
2. Berger S, Raman G, Vishwanathan R, Jacques PF, Johnson EJ. Dietary cholesterol and cardiovascular disease. Am J Clin Nutr. 2015;102(2):276-294.
3. US Department of Agriculture. USDA Food Composition Databases.https://ndb.nal.usda.gov/ndb/. Accessed March 25, 2019.
4. Shin JY, Xun P, Nakamura Y, He K. Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis. Am J Clin Nutr. 2013;98(1):146-159.
5. Alexander DD, Miller PE, Vargas AJ, Weed DL, Cohen SS. Meta-analysis of egg consumption and risk of coronary heart disease and stroke. J Am Coll Nutr. 2016;35(8):704-716.
6. Rong Y, Chen L, Zhu T, et al. Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies. BMJ. 2013;346:e8539.
7. Xu L, Lam TH, Jiang CQ, et al. Egg consumption and the risk of cardiovascular disease and all-cause mortality: Guangzhou Biobank Cohort Study and meta-analyses [published online April 21, 2018]. Eur J Nutr. doi:10.1007/s00394-018-1692-3
8. Li Y, Zhou C, Zhou X, Li L. Egg consumption and risk of cardiovascular diseases and diabetes. Atherosclerosis. 2013;229(2):524-530.
9. Khawaja O, Singh H, Luni F, et al. Egg consumption and incidence of heart failure: a meta-analysis of prospective cohort studies. Front Nutr. 2017;4:10.

This article originally appeared on The Cardiology Advisor