(23-04-2017) A Prospective Study of Egg Consumption and Risk of Cardiovascular Disease in Men and Women

Frank B. Hu, MD; Meir J. Stampfer, MD; Eric B. Rimm, ScD; et alJoAnn E. Manson, MD; Alberto Ascherio, MD; Graham A. Colditz, MD; Bernard A. Rosner, PhD; Donna Spiegelman, ScD; Frank E. Speizer, MD; Frank M. Sacks, MD; Charles H. Hennekens, MD; Walter C. Willett, MD
Author Affiliations
Author Affiliations: Departments of Nutrition (Drs Hu, Stampfer, Rimm, Ascherio, Sacks, and Willet), Epidemiology (Drs Stampfer, Rimm, Manson, Ascherio, Spiegelman, Hennekens, and Willet), and Biostatistics (Drs Spiegelman and Rosner), Harvard School of Public Health; Channing Laboratory (Drs Stampfer, Rimm, Manson, Colditz, Rosner, Speizer, and Willet), and the Division of Preventive Medicine (Drs Manson and Hennekens), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.



Abstract
Context Reduction in egg consumption has been widely recommended to lower blood cholesterol levels and prevent coronary heart disease (CHD). Epidemiologic studies on egg consumption and risk of CHD are sparse.

Objective To examine the association between egg consumption and risk of CHD and stroke in men and women.

Design and Setting Two prospective cohort studies, the Health Professionals Follow-up Study (1986-1994) and the Nurses' Health Study (1980-1994).

Participants A total of 37,851 men aged 40 to 75 years at study outset and 80,082 women aged 34 to 59 years at study outset, free of cardiovascular disease, diabetes, hypercholesterolemia, or cancer.

Main Outcome Measures Incident nonfatal myocardial infarction, fatal CHD, and stroke corresponding to daily egg consumption as determined by a food-frequency questionnaire.

Results We documented 866 incident cases of CHD and 258 incident cases of stroke in men during 8 years of follow-up and 939 incident cases of CHD and 563 incident cases of stroke in women during 14 years of follow-up. After adjustment for age, smoking, and other potential CHD risk factors, we found no evidence of an overall significant association between egg consumption and risk of CHD or stroke in either men or women. The relative risks (RRs) of CHD across categories of intake were less than 1 per week (1.0), 1 per week (1.06), 2 to 4 per week (1.12), 5 to 6 per week (0.90), and ≥1 per day (1.08) (P for trend=.75) for men; and less than 1 per week (1.0), 1 per week (0.82), 2 to 4 per week (0.99), 5 to 6 per week (0.95), and ≥1 per day (0.82) (P for trend=.95) for women. In subgroup analyses, higher egg consumption appeared to be associated with increased risk of CHD only among diabetic subjects (RR of CHD comparing more than 1 egg per day with less than 1 egg per week among diabetic men, 2.02 [95% confidence interval, 1.05-3.87; P for trend=.04], and among diabetic women, 1.49 [0.88-2.52; P for trend=.008]).

Conclusions These findings suggest that consumption of up to 1 egg per day is unlikely to have substantial overall impact on the risk of CHD or stroke among healthy men and women. The apparent increased risk of CHD associated with higher egg consumption among diabetic participants warrants further research.

Elevated low-density lipoprotein (LDL) cholesterol is a major risk factor for coronary heart disease (CHD).1 Dietary cholesterol raises LDL cholesterol levels and causes atherosclerosis in numerous animal models.2 In controlled metabolic studies conducted in humans, dietary cholesterol raises levels of total and LDL cholesterol in blood,3,4 but the effects are relatively small compared with saturated and transfatty acids.5,6 Studies have found that individuals vary widely in their responses to dietary cholesterol based on monitoring their plasma levels.7,8 Prospective cohort studies on the relationship of dietary cholesterol with risk of CHD have been inconsistent, with a significant association found in some,9,10 but not in most studies.11- 17

To avoid elevations in blood cholesterol and reduce CHD risk, the public has been advised to consume no more than 300 mg/d of cholesterol and limit consumption of eggs, which contain about 213 mg of cholesterol per egg.1,18 However, eggs contain many other nutrients besides cholesterol, including unsaturated fats, essential amino acids, folate, and other B vitamins. In addition, consumption of eggs instead of carbohydrate-rich foods may raise high-density lipoprotein (HDL) cholesterol levels19,20 and decrease blood glycemic and insulinemic responses.21 For these reasons, it is useful to study directly the relationship of egg consumption with risk of CHD, but few epidemiologic studies have addressed this association.22- 24 In this article, we examine prospectively the association between egg consumption and risk of CHD and stroke in 2 large cohorts of men and women.

Source: JAMA. 1999;281(15):1387-1394. doi:10.1001/jama.281.15.1387

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