Dietary Cholesterol or Egg Consumption and CVD and Mortality

Study Questions:

Is dietary consumption or egg consumption associated with cardiovascular disease (CVD) and all-cause mortality?


Individual participant data were pooled from six prospective US cohorts over 21 years (1986-2006). Self-reported diet data were harmonized using a standardized protocol. Key measurables included dietary cholesterol in mg/day or egg consumption as number/day. Outcomes included hazard ratio (HR) and absolute risk difference (ARD) over the entire follow-up for incident CVD defined as composite of fatal and nonfatal coronary heart disease, stroke, heart failure, and other CVD deaths and all-cause mortality adjusting for demographics and socioeconomic and behavioral factors.


The six cohorts had 29,615 participants (mean age 51.6 years at baseline). At a median follow-up of 17.5 years, 18% had CVD events and there were 21% all-cause deaths. Each additional 300 mg of dietary cholesterol consumed per day was significantly associated with higher risk of incident CVD (adjusted HR, 1.17; adjusted ARD, 3.24%) and all-cause mortality (adjusted HR, 1.18; adjusted ARD, 4.43%). Each additional half an egg consumed per day was significantly associated with higher risk of incident CVD (adjusted HR, 1.06; adjusted ARD, 1.11%) and all-cause mortality (adjusted HR, 1.08; adjusted ARD, 1.93%). The associations between egg consumption and incident CVD were no longer significant after adjusting for dietary cholesterol consumption.


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.


The inconclusive results of several meta-analyses of egg consumption and CVD influenced recent dietary guidelines to liberalize egg consumption. In contrast, this very rigorous study had longer follow-up and access to study details regarding the unhealthy lifestyle that may be associated with eggs and other sources of cholesterol including less physical activity, smoking, and diets rich in saturated fat and animal protein. Very important was the significant association of dietary cholesterol with incident CVD and all-cause mortality independent of total fat and quality of the diet.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Lipid Metabolism, Nonstatins, Acute Heart Failure, Diet, Exercise, Smoking

Keywords: ACC19, ACC Annual Scientific Session, Cholesterol, Cholesterol, Dietary, Coronary Disease, Diet, Eggs, Egg Proteins, Dietary, Exercise, Heart Failure, Life Style, Primary Prevention, Smoking, Stroke, Vascular Diseases

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