In 2013, after decades of research, the American Heart Association and the American College of Cardiology published a new guideline on lifestyle management to reduce cardiovascular risk which concluded, “There is insufficient evidence to determine whether lowering dietary cholesterol reduces LDL-cholesterol1.”  This was followed by the removal of the 300 mg per day cholesterol restriction within the 2015 Dietary Guidelines for Americans and a greater focus on overall healthy dietary patterns2.  Today, eggs are recommended as part of heathy eating patterns by both the Dietary Guidelines for Americans and the American Heart Association3,4.  Yet, many people, including health professionals, remain concerned about dietary cholesterol5.

In a new article published in Hot Topics in Primary Care, a special supplement to the Journal of Family Practice, Dr. Maria Luz Fernandez highlights recent research around eggs and cardiovascular health and highlights the evolution of science around the impact of dietary cholesterol on blood cholesterol6.  While the science is clear that elevated LDL-cholesterol increases the risk for cardiovascular disease, the impact of dietary cholesterol and egg intake is not straightforward.  For most people, egg consumption does not impact blood cholesterol levels.  For those whose blood cholesterol responds to dietary cholesterol, generally there is an increase in both LDL-cholesterol and HDL-cholesterol, leaving the ratio between the two unchanged. The ratio of LDL to HDL is recognized as an important indicator of cardiovascular disease risk7.

Further, if there is a change in blood cholesterol secondary to egg consumption, the lipoproteins generated tend to be large, less atherogenic LDL particles that are “preferentially removed by [the] liver rather than by endothelial cells.”  The HDL particles generated secondary to egg consumption have improved functionality and a larger surface area which can transport a higher concentration of carotenoids6.  Overall, these exciting data illustrate that science has moved far beyond looking at the impact of isolated dietary cholesterol on total blood cholesterol, and instead, we are now evaluating the impact of foods (i.e.eggs) on health outcomes.

Most recent publications demonstrate egg consumption is not associated with cardiovascular disease risk8-10, and that is the basis for current guidelines that recommend eggs across the lifespan.  It is important to recognize the benefits of eggs within the diet and their role in optimizing health.  Dr. Fernandez lists several protective effects of eggs6:

  • Generation of HDL-cholesterol with improved function11,12
  • Highly bioavailable lutein and zeaxanthin, carotenoids known to accumulate in the eye and reduce risk of age-related macular degeneration13
  • An excellent source of choline, which is essential for brain health
  • High quality protein for maintenance of health

While the American Heart Association identifies a research gap for people who have abnormal blood lipids4, a growing body of evidence demonstrates eggs can be beneficial even for people at risk of cardiovascular disease11,14,15.  Of course, an overall healthy diet pattern is essential for maintenance of health3,4. For meal inspiration, check out our collection of heart-healthy recipes.

Photo by Sara Haas, RDN.

  1. Eckel, R.H., et al., 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 2014. 129(25 Suppl 2): p. S76-99.

  2. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015-2020 Dietary Guidelines for Americans. 2015; 8:[Available from: http://health.gov/dietaryguidelines/2015/guidelines/].

  3. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2020-2025 Dietary Guidelines for Americans. 2020; Available from: https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf.

  4. Carson, J.A.S., et al., Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association. Circulation, 2019: p. Cir0000000000000743.

  5. Ipsos, American Egg Board Nutrition Messaging Project. 2021.

  6. Fernandez, M.L., The Role of Eggs in Healthy Diets. Supplement to the Journal of Family Practice, 2022. 71(6): p. S71-S75.

  7. Blesso, C.N. and M.L. Fernandez, Dietary Cholesterol, Serum Lipids, and Heart Disease: Are Eggs Working for or Against You? Nutrients, 2018. 10(4).

  8. Drouin-Chartier, J.P., et al., Egg consumption and risk of cardiovascular disease: three large prospective US cohort studies, systematic review, and updated meta-analysis. Bmj, 2020. 368: p. m513.

  9. Dehghan, M., et al., Association of egg intake with blood lipids, cardiovascular disease, and mortality in 177,000 people in 50 countries. Am J Clin Nutr, 2020.

  10. Shin, J.Y., et al., Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis. Am J Clin Nutr, 2013. 98(1): p. 146-59.

  11. Sawrey-Kubicek, L., et al., Whole egg consumption compared with yolk-free egg increases the cholesterol efflux capacity of high-density lipoproteins in overweight, postmenopausal women. Am J Clin Nutr, 2019.

  12. Andersen, C.J., et al., Egg consumption modulates HDL lipid composition and increases the cholesterol-accepting capacity of serum in metabolic syndrome. Lipids, 2013. 48(6): p. 557-67.

  13. Johnson, E.J., Role of lutein and zeaxanthin in visual and cognitive function throughout the lifespan. Nutr Rev, 2014. 72(9): p. 605-12.

  14. Njike, V.Y., et al., Egg Consumption in the Context of Plant-Based Diets and Cardiometabolic Risk Factors in Adults at Risk of Type 2 Diabetes. The Journal of Nutrition, 2021. 151(12): p. 3651-3660.

  15. Thomas, M.S., et al., Eggs Improve Plasma Biomarkers in Patients with Metabolic Syndrome Following a Plant-Based Diet-A Randomized Crossover Study.
    Nutrients, 2022.14(10).