Associations of Dietary Cholesterol or Egg Consumption With Incident Cardiovascular Disease and Mortality
Zhong VW, Van Horn L, Cornelis MC, Wilkins JT, Ning H, Carnethon MR, Greenland P, Mentz RJ, Tucker KL, Zhao L, Norwood AF, Lloyd-Jones DM, Allen NB
JAMA · 227 citations
How it was studied
- Design
- Cohort study (indexed by PubMed)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
- Intake measured by
- Not stated
Who paid for it
- Funding
- Independent funding
- Government
- National Heart, Lung, and Blood Institute
- Government
- National Institute of Diabetes and Digestive and Kidney Diseases
- Government
- NHLBI NIH HHS
- Government
- NIDDK NIH HHS
- Grants
- National Heart, Lung, and Blood Institute (HHSN268201300050C); National Heart, Lung, and Blood Institute (HHSN268201300046C); National Heart, Lung, and Blood Institute (R21HL085375); National Heart, Lung, and Blood Institute (R01 HL136942); National Heart, Lung, and Blood Institute (HHSN268201300048C); National Heart, Lung, and Blood Institute (HHSN268201300049C); National Heart, Lung, and Blood Institute (HHSN268201300047C); National Heart, Lung, and Blood Institute (K23 HL133601); National Institute of Diabetes and Digestive and Kidney Diseases (P30-DK092949)
Based on 4 listed funder(s).
Publication
- Published
- 2019-03-15 · JAMA · vol. 321 · issue 11 · p. 1081
- Publisher
- American Medical Association
- Cited
- 332 citations · more than 100% of similar papers · 45.5× the field average
- Impact
- Top 10% most cited in its field
- References
- 38 works
- Access
- Free to read
- Research areas
- Nutritional Studies and Diet · Cardiovascular Health and Risk Factors · Sodium Intake and Health
- Keywords
- Medicine, Interquartile range, Hazard ratio, Cholesterol, Internal medicine, Confidence interval
- MeSH
- humans, cardiovascular diseases, cholesterol, dietary, diet, nutrition surveys, mortality, risk factors, prospective studies, eggs, adult, aged, middle aged, female, male, self report
13 authors
From US
- Victor W. Zhong · correspondingNorthwestern University
- Linda Van HornNorthwestern University
- Marilyn C. CornelisNorthwestern University
- John T. WilkinsNorthwestern University
- Hongyan NingNorthwestern University
- Mercedes R. CarnethonNorthwestern University
Abstract
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.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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