Medical Bulletin 30/ March/ 2024

Are eggs bad for your heart?

Results from a prospective, controlled trial presented at the American College of Cardiology’s Annual Scientific Session revealed that over a four-month period, cholesterol levels were similar among people who ate eggs most days of the week compared with those who didn’t eat eggs.

Eggs are a common and relatively inexpensive source of protein and dietary cholesterol. Whether you like your eggs sunny-side up, hard-boiled or scrambled, many hesitate to eat them amid concerns that eggs may raise cholesterol levels and be bad for heart health.

“We know that cardiovascular disease is, to some extent, mediated through risk factors like high blood pressure, high cholesterol and increased BMI and diabetes. Dietary patterns and habits can have a notable influence on these and there’s been a lot of conflicting information about whether or not eggs are safe to eat, especially for people who have or are at risk for heart disease. This is a small study, but it gives us reassurance that eating eggs is OK with regard to lipid effects over four months, even among a more high-risk population,” said Nina Nouhravesh, MD, a research fellow at the Duke Clinical Research Institute in Durham, North Carolina, and the study’s lead author.

A total of 140 patients with or at high risk for cardiovascular disease were enrolled in the PROSPERITY trial, which aimed to assess the effects of eating 12 or more eggs a week versus a non-egg diet (consuming less than two eggs a week) on HDL- and LDL-cholesterol, as well as other key markers of cardiovascular health over a four-month study period. Secondary endpoints included lipid, cardiometabolic and inflammatory biomarkers and levels of vitamins and minerals. Patients had in-person clinic visits at the start of the study and visits at one and four months to take vital signs and have bloodwork done.

“While this is a neutral study, we did not observe adverse effects on biomarkers of cardiovascular health and there were signals of potential benefits of eating eggs that warrant further investigation in larger studies as they are more hypothesis generating here,” said Nouhravesh, explaining that subgroup analyses revealed numerical increases in HDL cholesterol and reductions in LDL cholesterol in patients 65 years or older and those with diabetes in the 12-egg group compared with those eating fewer than two eggs.

Reference: Prospective Evaluation of Fortified Eggs Related to Improvement in the Biomarker Profile for Your Health: Primary Results from the PROSPERITY Trial, American College of Cardiology's Annual Scientific Session

Can sweeteners raise your appetite level?

A study published in the journal EBioMedicine revealed that replacing sugar with artificial and natural sweeteners in foods does not make people hungrier – and also helps to reduce blood sugar levels.

The research trial, led by the University of Leeds in collaboration with The Rhône-Alpes Research Center for Human Nutrition, found that consuming food containing sweeteners produced a similar reduction in appetite sensations and appetite-related hormone responses as sugary foods - and provides some benefits such as lowering blood sugar, which may be particularly important in people at risk of developing type 2 diabetes. However, the use of sweeteners in place of sugar in foods can be controversial due to conflicting reports about their potential to increase appetite.

“Simply restricting sugar from foods without substitution may negatively impact its taste or increase sweet cravings, resulting in difficulties sticking to a low-sugar diet. Replacing sugars with sweeteners and sweetness enhancers in food products is one of the most widely used dietary and food manufacturing strategies to reduce sugar intake and improve the nutritional profile of commercial foods and beverages.” said lead author Catherine Gibbons, Associate Professor in the University of Leeds’ School of Psychology.

The study examined the effects of consuming biscuits with different sweeteners on 53 overweight or obese adults. The trial included three two-week periods where participants ate biscuits with sugar, natural sweetener Stevia, or artificial sweetener Neotame. Baseline measurements were taken before and after consuming the biscuits, including glucose, insulin, and appetite-related hormones. Participants also rated their appetite and food preferences.

The results revealed that the two sweetener types showed no differences in appetite or endocrine responses compared to sugar, but insulin levels measured over two hours after eating were reduced, as were blood sugar levels.

“The use of sweeteners and sweetness enhancers has received a lot of negative attention, including high profile publications linking their consumption with impaired glycaemic response, toxicological damage to DNA and increased risk of heart attack and stroke. These reports contribute to the current befuddlement concerning the safety of sweeteners and sweetness enhancers among the general public and especially people at risk of metabolic diseases. Our study provides crucial evidence supporting the day-to-day use of sweeteners and sweetness enhancers for body weight and blood sugar control.” said Finlayson.

Reference: Acute and two-week effects of Neotame, Stevia Rebaudioside M and sucrosesweetened biscuits on postprandial appetite and endocrine response in adults with overweight/obesity – a randomised crossover trial from the SWEET Consortium; Journal: EBioMedicine

Mental health may predict heart health in younger women, finds study

A new study presented at the American College of Cardiology’s Annual Scientific Session found that having anxiety or depression could accelerate the development of cardiovascular risk factors among young and middle-aged women.

Younger women are generally thought to have a low risk of heart disease, but new research urges clinicians to revisit that assumption, especially for women who suffer from certain mental health conditions and reported that younger women with anxiety or depression were nearly twice as likely to develop high blood pressure, high cholesterol or diabetes over a 10-year period compared with women who did not have these mental health conditions, putting them nearly on par with men of the same age in terms of heart disease risk.

“We often feel that young women are the ‘safe group’ with regards to cardiovascular disease because the incidence of cardiovascular disease is quite low due to the protective effects of estrogen in this group. But this study suggests that if a younger woman has depression or anxiety, we should start screening for cardiovascular risk factors to reduce the incidence of cardiovascular disease.” said Giovanni Civieri, MD, cardiologist, research fellow at Massachusetts General Hospital and Harvard Medical School, and the study’s lead author.

In the study, researchers analyzed health records of 71,214 people participating in the Mass General Brigham Biobank. People who had heart disease or who were diagnosed with anxiety or depression after the study began were excluded. They also examined the metabolic activity of stress-related brain regions in a subset of participants who had undergone brain scans.

The results revealed that during a 10-year follow-up, 38% of participants developed high blood pressure, high cholesterol, or diabetes. Those with pre-existing anxiety or depression were 55% more likely to develop these risk factors. Women under 50 with anxiety or depression were nearly twice as likely to develop cardiovascular risk factors. Despite young women typically having lower risk, anxiety and depression increased their relative risk significantly, possibly due to heightened stress-related neural activity.

“Once a young woman has depression or anxiety, her absolute risk is comparable to a young male. There is a sort of a catch-up phenomenon where depression and anxiety increase the risk that would otherwise be very low,” said Civieri

Reference: “Anxiety and Depression Increase Cardiovascular Disease Risk by Accelerating the Development of Risk Factors: Effects of Age and Sex; American College of Cardiology's Annual Scientific Session