Online citations, reference lists, and bibliographies.
← Back to Search

Associations Of Dietary Cholesterol Or Egg Consumption With Incident Cardiovascular Disease And Mortality

V. W. Zhong, L. V. Van Horn, M. Cornelis, J. Wilkins, H. Ning, M. Carnethon, P. Greenland, R. Mentz, K. Tucker, Lihui Zhao, A. F. Norwood, D. Lloyd-Jones, N. Allen
Published 2019 · Medicine

Save to my Library
Download PDF
Analyze on Scholarcy Visualize in Litmaps
Share
Reduce the time it takes to create your bibliography by a factor of 10 by using the world’s favourite reference manager
Time to take this seriously.
Get Citationsy
Importance Cholesterol is a common nutrient in the human diet and eggs are a major source of dietary cholesterol. Whether dietary cholesterol or egg consumption is associated with cardiovascular disease (CVD) and mortality remains controversial. Objective To determine the associations of dietary cholesterol or egg consumption with incident CVD and all-cause mortality. Design, Setting, and Participants Individual participant data were pooled from 6 prospective US cohorts using data collected between March 25, 1985, and August 31, 2016. Self-reported diet data were harmonized using a standardized protocol. Exposures Dietary cholesterol (mg/day) or egg consumption (number/day). Main Outcomes and Measures Hazard ratio (HR) and absolute risk difference (ARD) over the entire follow-up for incident CVD (composite of fatal and nonfatal coronary heart disease, stroke, heart failure, and other CVD deaths) and all-cause mortality, adjusting for demographic, socioeconomic, and behavioral factors. Results This analysis included 29 615 participants (mean [SD] age, 51.6 [13.5] years at baseline) of whom 13 299 (44.9%) were men and 9204 (31.1%) were black. During a median follow-up of 17.5 years (interquartile range, 13.0-21.7; maximum, 31.3), there were 5400 incident CVD events and 6132 all-cause deaths. The associations of dietary cholesterol or egg consumption with incident CVD and all-cause mortality were monotonic (all P values for nonlinear terms, .19-.83). Each additional 300 mg of dietary cholesterol consumed per day was significantly associated with higher risk of incident CVD (adjusted HR, 1.17 [95% CI, 1.09-1.26]; adjusted ARD, 3.24% [95% CI, 1.39%-5.08%]) and all-cause mortality (adjusted HR, 1.18 [95% CI, 1.10-1.26]; adjusted ARD, 4.43% [95% CI, 2.51%-6.36%]). Each additional half an egg consumed per day was significantly associated with higher risk of incident CVD (adjusted HR, 1.06 [95% CI, 1.03-1.10]; adjusted ARD, 1.11% [95% CI, 0.32%-1.89%]) and all-cause mortality (adjusted HR, 1.08 [95% CI, 1.04-1.11]; adjusted ARD, 1.93% [95% CI, 1.10%-2.76%]). The associations between egg consumption and incident CVD (adjusted HR, 0.99 [95% CI, 0.93-1.05]; adjusted ARD, −0.47% [95% CI, −1.83% to 0.88%]) and all-cause mortality (adjusted HR, 1.03 [95% CI, 0.97-1.09]; adjusted ARD, 0.71% [95% CI, −0.85% to 2.28%]) were no longer significant after adjusting for dietary cholesterol consumption. Conclusions and Relevance 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.
This paper references
10.1016/0091-7435(75)90037-7
The Framingham Offspring Study. Design and preliminary data.
M. Feinleib (1975)
10.1016/0895-4356(88)90080-7
CARDIA: study design, recruitment, and some characteristics of the examined subjects.
G. Friedman (1988)
10.1093/oxfordjournals.aje.a115184
The Atherosclerosis Risk in Communities (ARIC) Study: design and objectives. The ARIC investigators.
M. Szklo (1989)
10.1093/BIOMET/80.3.557
Checking the Cox model with cumulative sums of martingale-based residuals
D. Lin (1993)
Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies
R Clarke (1997)
10.1001/JAMA.281.15.1387
A prospective study of egg consumption and risk of cardiovascular disease in men and women.
F. Hu (1999)
10.1093/AJE/KWF113
Multi-Ethnic Study of Atherosclerosis: objectives and design.
D. Bild (2002)
10.1016/S0002-8223(02)90346-9
Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids.
P. Trumbo (2002)
10.1001/JAMA.290.1.38
Nut consumption and risk of type 2 diabetes.
E. Parker (2003)
Toward resolution of cardiovascular health disparities in African Americans: design and methods of the Jackson Heart Study.
H. Taylor (2005)
Cardiovascular disease event classification in the Jackson Heart Study: methods and procedures.
E. Keku (2005)
10.1001/archinte.168.7.713
Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women.
T. Fung (2008)
10.1093/aje/kwp107
Competing risk regression models for epidemiologic data.
B. Lau (2009)
10.1161/CIRCULATIONAHA.108.816736
Mediterranean Diet and Incidence of and Mortality From Coronary Heart Disease and Stroke in Women
T. Fung (2009)
10.1002/sim.4067
Multiple imputation using chained equations: Issues and guidance for practice.
I. White (2011)
10.3945/jn.111.157222
Alternative dietary indices both strongly predict risk of chronic disease.
S. Chiuve (2012)
10.1056/NEJMoa1012848
Lifetime risks of cardiovascular disease.
J. Berry (2012)
10.1001/jama.2012.14312
Lifetime risk and years lived free of total cardiovascular disease.
John T. Wilkins (2012)
10.1016/j.gheart.2012.12.001
Legacy of the framingham heart study: rationale, design, initial findings, and implications.
N. Wong (2013)
10.1016/j.atherosclerosis.2013.04.003
Egg consumption and risk of cardiovascular diseases and diabetes: a meta-analysis.
Y. Li (2013)
10.1016/j.jacc.2013.01.022
Lifetime risk for heart failure among white and black Americans: cardiovascular lifetime risk pooling project.
M. Huffman (2013)
10.1136/bmj.e8539
Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies
Ying Rong (2013)
10.3945/ajcn.112.051318
Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis.
J. Shin (2013)
10.1136/bmj.g2272
Global, regional, and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys
R. Micha (2014)
10.1001/jamainternmed.2014.3422
Trends in dietary quality among adults in the United States, 1999 through 2010.
D. Wang (2014)
10.1093/ije/dyv150
Data Resource Profile: The Cardiovascular Disease Lifetime Risk Pooling Project.
J. Wilkins (2015)
10.3945/ajcn.114.100305
Dietary cholesterol and cardiovascular disease: a systematic review and meta-analysis.
Samantha E Berger (2015)
10.1093/ije/dyv337
Cohort Profile: The Framingham Heart Study (FHS): overview of milestones in cardiovascular epidemiology.
C. Tsao (2015)
10.1080/07315724.2016.1152928
Meta-analysis of Egg Consumption and Risk of Coronary Heart Disease and Stroke
D. Alexander (2016)
10.3945/ajcn.115.119933
Egg consumption and risk of type 2 diabetes: a meta-analysis of prospective studies.
L. Djoussé (2016)
10.1161/CIRCULATIONAHA.115.017719
Introduction to the Analysis of Survival Data in the Presence of Competing Risks
P. Austin (2016)
10.3390/nu9040333
Time Trends and Patterns of Reported Egg Consumption in the U.S. by Sociodemographic Characteristics
Zach Conrad (2017)
10.3389/fnut.2017.00010
Egg Consumption and Incidence of Heart Failure: A Meta-Analysis of Prospective Cohort Studies
O. Khawaja (2017)
10.1001/jama.2018.13551
Association of Blood Pressure Classification in Young Adults Using the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline With Cardiovascular Events Later in Life
Yuichiro Yano (2018)
10.1007/s00394-018-1692-3
Egg consumption and the risk of cardiovascular disease and all-cause mortality: Guangzhou Biobank Cohort Study and meta-analyses
L. Xu (2018)
10.3390/nu10060771
Dietary Cholesterol Intake and Sources among U.S Adults: Results from National Health and Nutrition Examination Surveys (NHANES), 2001–2014
Z. Xu (2018)
pec” (Version 2018.07.26): prediction error curves for risk predictionmodels in survival analysis. https://cran.r-project.org/web/ packages/pec/pec.pdf
R Package (2019)
riskRegression” (Version 2019.01.29): risk regressionmodels and prediction scores for survivalanalysis with competing risks. https://cran.r-project.org/web/packages/ riskRegression/riskRegression.pdf
R Package (2019)
survival” (Version 2.43-3): Survival analysis. https://cran.r-project.org/web/packages/ survival/survival.pdf
R Package (2019)
of Agriculture
US Departmen (2019)
of Health and Human Services and US Department of Agriculture
US Departmen (2019)
The PHREG procedure: type 3 tests and joint tests
SAS Institute (2019)



This paper is referenced by
10.1371/journal.pmed.1003508
Egg and cholesterol consumption and mortality from cardiovascular and different causes in the United States: A population-based cohort study.
P. Zhuang (2021)
10.1161/JAHA.119.015553
Association of Major Dietary Protein Sources With All‐Cause and Cause‐Specific Mortality: Prospective Cohort Study
Yangbo Sun (2021)
10.1016/J.ANIFEEDSCI.2021.114854
Garlic oil granules coated with enteric polymer: Effects on performance, egg quality, yolk antioxidants, yolk cholesterol, blood biochemistry and hepatic lipid metabolism in laying hens
P. Rodjan (2021)
10.18388/abp.2020_5515
Mediterranean, vegetarian and vegan diets as practical outtakes of EAS and ACC/AHA recommendations for lowering lipid profile.
A. Wojda (2021)
10.3390/foods10030494
Nutritional Viewpoints on Eggs and Cholesterol
M. Sugano (2021)
10.1007/s00394-021-02536-w
Egg consumption and risk of all-cause and cause-specific mortality in an Italian adult population
E. Ruggiero (2021)
10.1161/JAHA.120.019681
Estimated Impact of Achieving Optimal Cardiovascular Health Among US Adults on Cardiovascular Disease Events
Joshua D. Bundy (2021)
10.1016/j.clnu.2021.03.003
Egg consumption, overall diet quality, and risk of type 2 diabetes and coronary heart disease: A pooling project of US prospective cohorts.
L. Djoussé (2021)
10.3390/nu13062094
Cholesterol and Egg Intakes with Cardiometabolic and All-Cause Mortality among Chinese and Low-Income Black and White Americans
X. Pan (2021)
10.1038/s41591-020-01183-8
Microbiome connections with host metabolism and habitual diet from 1,098 deeply phenotyped individuals
F. Asnicar (2021)
10.1007/s40138-021-00225-w
Egg Consumption and Risk of Cardiovascular Disease: a Critical Review
Joshua Hahn (2021)
10.1161/JAHA.120.017066
Cardiovascular Harm From Egg Yolk and Meat: More Than Just Cholesterol and Saturated Fat
J. Spence (2021)
10.1093/cdn/nzaa181
Modeling the Removal and Addition of Eggs in the Current US Diet is Linked to Choline and Lutein + Zeaxanthin Usual Intakes in Childhood
Y. Papanikolaou (2021)
10.36660/abc.20201340
Posicionamento sobre o Consumo de Gorduras e Saúde Cardiovascular – 2021
M. C. Izar (2021)
10.1136/gutjnl-2020-323877
Blue poo: impact of gut transit time on the gut microbiome using a novel marker
Francesco Asnicar (2021)
10.3390/foods10030624
The Heterogeneity of Consumer Preferences for Meat Safety Attributes in Traditional Markets
Widya Satya Nugraha (2021)
10.3390/jcdd8040036
Obesity Does Not Interfere with the Cholesterol-Lowering Effect of Plant Stanol Ester Consumption (as Part of a Heart-Healthy Diet)
P. Simonen (2021)
10.1177/20533691211018449
News and views
Simon Brown (2021)
10.3389/fnut.2021.652192
RNA Sequencing Reveals Key Metabolic Pathways Are Modified by Short-Term Whole Egg Consumption
Amanda E. Bries (2021)
PenDer: Incorporating Shape Constraints via Penalized Derivatives
Akhil Gupta (2021)
10.1007/s12161-020-01962-6
Development and Validation of a Method to Simultaneously Determine Multiple Sterols in Diversiform Food Substrates with UPLC-MS/MS
Chenggang Han (2021)
10.1186/s12937-021-00720-6
Association between egg consumption and arterial stiffness: a longitudinal study
Naiwen Ji (2021)
10.1161/JAHA.119.015743
Dietary Intakes of Eggs and Cholesterol in Relation to All‐Cause and Heart Disease Mortality: A Prospective Cohort Study
P. Xia (2020)
10.3389/fnut.2020.00153
Egg Consumption and Stroke Risk: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies
Hui Tang (2020)
10.1093/ajcn/nqz348
Association of egg intake with blood lipids, cardiovascular disease, and mortality in 177,000 people in 50 countries.
M. Dehghan (2020)
10.1001/jamainternmed.2019.6969
Associations of Processed Meat, Unprocessed Red Meat, Poultry, or Fish Intake With Incident Cardiovascular Disease and All-Cause Mortality.
V. Zhong (2020)
10.1016/j.pmedr.2020.101102
Change in an urban food environment within a single year: Considerations for food-environment research and community health
S. Lucan (2020)
10.3390/nu12051350
Cholesterol and Egg Intakes, and Risk of Hypertension in a Large Prospective Cohort of French Women
C. MacDonald (2020)
10.3390/nu12082346
Lowering Low-Density Lipoprotein Cholesterol Concentration with Plant Stanol Esters to Reduce the Risk of Atherosclerotic Cardiovascular Disease Events at a Population Level: A Critical Discussion
H. Gylling (2020)
10.1097/MED.0000000000000589
Dietary management of cardiovascular risk including type 2 diabetes.
P. Nestel (2020)
10.1097/JCN.0000000000000640
PCNA News.
(2020)
10.1016/j.ajpc.2020.100106
Top 10 dietary strategies for atherosclerotic cardiovascular risk reduction
G. Sikand (2020)
See more
Semantic Scholar Logo Some data provided by SemanticScholar