Increased intake of eggs and Dietary Cholesterol may raise risk of CVD linked mortality

For over two decades, epidemiological studies have evaluated the associations between higher dietary cholesterol and egg consumption and disease risk, with conflicting findings. To provide evidence from a more comprehensive assessment relevant to dietary guidelines and healthy dietary patterns, Dr Jiaqi Huang and his team conducted a study to examine overall and cause-specific mortality in relation to dietary and serum cholesterol, as well as egg consumption, and they further conduct an updated meta-regression analysis of cohort studies.

In a prospective analysis of Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) study, the researchers included 27,078 patients. They calculated hazard ratios (HR) and 31-year absolute mortality risk differences (ARD) using multivariable-controlled cause-specific Cox proportional hazards regression models. They also performed a systematic review and meta-analysis of cohort studies.

Key findings of the study:

• Based on 482,316 person-years of follow-up, the researchers observed 22,035 deaths, including 9,110 deaths from CVD.
• They found that greater dietary cholesterol and egg consumption was associated with increased CVD risk and mortality.
• They noted that the HRs for each additional 300 mg cholesterol intake per day were 1.10 and 1.13 for overall and CVD mortality (respectively), and for each additional 50 g egg consumed daily HRs were 1.06 and 1.09, respectively, for overall and CVD mortality.
• Upon multivariable adjustment, higher serum total cholesterol concentrations were associated with an increased risk of CVD mortality (HRs per 1-SD increment: 1.14).
• They noted that the observed associations were generally similar across cohort subgroups.
• In an updated meta-analysis of cohort studies based on 49 risk estimates, they found that the consumption of one additional 50 g egg daily was associated with significantly increased CVD risk: pooled RR=1.04.
• Upon subgroup analysis of geographical regions, they noted that an increase of 50 g of egg consumed daily was associated with a higher risk of CVD among US cohorts (pooled-RR=1.08), appeared related to a higher CVD risk in European cohorts with a borderline significance (pooled-RR=1.05), but was not associated with CVD risk in Asian cohorts.

The authors concluded, "In this prospective cohort study and updated meta-analysis, greater dietary cholesterol and egg consumption were associated with increased risk of overall and CVD mortality. Our findings support restricted consumption of dietary cholesterol as a means to improve long-term health and longevity."

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DOI: https://doi.org/10.1161/CIRCULATIONAHA.121.057642