Log in to MyACC
Associations of Cholesterol and Egg Intake With Mortality
Quick Takes
- Greater consumption of dietary cholesterol and eggs is associated with an increased risk of overall and CVD mortality.
- There was a significant positive association with egg consumption and CVD risk in US cohorts, a marginal positive association in European cohorts, and no association in Asian cohorts.
- Restricted intake of dietary cholesterol may be associated with lower risk for CVD mortality.
Study Questions:
Is overall and cause-specific mortality associated with dietary and serum cholesterol, or egg consumption?
Methods:
Data from the ATBC (Alpha-Tocopherol, Beta-Carotene Cancer Prevention) study were used for the current analysis. The ATBC study was a controlled 2x2 factorial primary prevention trial conducted to examine supplementation with alpha-tocopherol (50 mg/d), beta-carotene (20 mg/d), or both in association with incident cancer. A total of 29,133 Finnish males, all current smokers, were recruited between 1985–1988, and were aged 50-69 years at the time of enrollment. The intervention ended in April 1993. The present study examined consumption of dietary cholesterol, serum cholesterol, and egg consumption collected through food frequency questionnaire with risk for mortality. Participants were followed from study entry until death or end of follow-up (December 2015). The primary outcomes, all-cause or cause-specific mortality, were assessed through linkage to the Causes of Death Registry, Statistics, Finland. A systematic review and meta-analysis of cohort studies was also performed.
Results:
A total of 27,078 men were included in the current study after excluding participants with missing data on dietary intake of cholesterol. A total of 22,035 deaths were identified over 482,316 person-years of follow-up, including 9,110 cardiovascular-related deaths. Median daily dietary cholesterol intake and egg consumption in ATBC were 538 mg (mean value: 582 mg) and 44.6 g (mean value: 53.3 g), respectively, and median serum total cholesterol was 240 mg/dL (6.2 mmol/L). Participants with greater cholesterol intake were more likely to have lower serum vitamin E concentrations, less education, and lower prevalence of diabetes and CVD. For each additional 300 mg cholesterol intake per day, there was an increased risk for overall and CVD-related mortality (hazard ratio [HR], 1.10; 95% confidence interval [CI], 1.06-1.13 and HR, 1.13; 95% CI, 1.08-1.18, respectively).
For each additional 50 g egg consumed daily, there was an increased risk of overall and CVD mortality, which was no longer statistically significant after adjustment for total dietary cholesterol. These associations were generally similar across cohort subgroups. The updated meta-analysis of cohort studies based on 49 risk estimates (3,601,401 participants, and 255,479 events) showed that consumption of one additional 50 g egg daily was associated with significantly increased CVD risk (pooled relative risk, 1.04; 95% CI, 1.00-1.08); I2, 80.1%. In the subgroup analysis of geographical regions, a higher risk of CVD was observed among US cohorts.
Conclusions:
The investigators concluded that in this prospective cohort study and updated meta-analysis, greater dietary cholesterol and egg consumption was associated with increased risk of overall and CVD mortality.
Perspective:
These data include a large study of Finnish men followed in the 1980s and 1990s, in which greater dietary cholesterol and egg consumption was associated with an increased risk for all-cause and CVD mortality. These data suggest that dietary cholesterol should be limited in the diet for overall cardiovascular health.
Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Diet, Smoking
Keywords: alpha-Tocopherol, beta Carotene, Cholesterol, Cholesterol, Dietary, Diabetes Mellitus, Diet, Dietary Supplements, Neoplasms, Primary Prevention, Smoking, Smokers, Vitamin E
< Back to Listings
