In late 2019, the American Heart Association (AHA) Nutrition Committee published a science advisory in which the authors state that “a recommendation that gives a specific dietary cholesterol target within the context of food-based advice is challenging for clinicians and consumers to implement; hence, guidance focused on dietary patterns is more likely to improve diet quality and to promote cardiovascular health.”1 The science advisory recommends heart-healthy eating patterns such as the Mediterranean-style and DASH (Dietary Approaches to Stop Hypertension)–style diets. Specifically, regarding eggs, the advisory concluded:
- Healthy individuals can include up to a whole egg daily in heart health dietary patterns.
- For older healthy individuals, given the nutritional benefits and convenience of eggs, consumption of up to 2 eggs per day is acceptable within the context of a heart-healthy dietary pattern.
- Vegetarians who do not consume meat-based cholesterol-containing foods may include more eggs in their diets within the context of moderation.
The AHA science advisory was clear that these recommendations were specific to otherwise healthy individuals, and that individuals “with dyslipidemia, particularly those with diabetes mellitus or at risk for heart failure, should be cautious in consuming foods rich in cholesterol.” Perhaps one reason for the cautious approach with this population is the lack of research on the association between egg intake and cardiovascular events in individuals with a history of cardiovascular disease, but a new study begins to shed some light on this very question.
The latest study, published in the American Journal of Clinical Nutrition assessed the association of egg consumption with blood lipids, cardiovascular disease, and mortality in 3 large international cohorts.2 In one cohort, the Prospective Urban Rural Epidemiology (PURE) study, egg consumption was assessed in 146,011 individuals from 21 countries. The researchers also studied 31,544 patients with vascular disease in 2 multinational studies: ONTARGET and TRANSCEND, both of which were originally designed to test treatments for hypertension.
The findings from the PURE cohort reinforced the 2019 AHA recommendations, finding no link between egg consumption and cardiovascular disease outcomes. In fact, in the PURE cohort, researchers found that higher egg intake was associated with a lower risk of myocardial infarction, a finding that is consistent with other recent studies of cohorts outside the U.S. 3,4 In the ONTARGET and TRANSCEND cohorts of individuals with vascular disease, the researchers also reported no link between egg consumption and cardiovascular events.
Thus, this latest paper both reinforces previous research regarding egg consumption in otherwise healthy individuals, but takes a big step forward in our understanding of this relationship in individuals with vascular disease.
- Carson JAS, Lichtenstein AH, Anderson CAM, Appel LJ, Kris-Etherton PM, Meyer KA, Petersen K, Polonsky T, Van Horn L; on behalf of the American Heart Association Nutrition Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Peripheral Vascular Disease; and Stroke Council. Dietary cholesterol and cardiovascular risk: a science advisory from the American Heart Association. Circulation. 2019;140: e-pub ahead of print.
- Dehghan 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. E-pub ahead of print.
- Key, T.J., et al., Consumption of Meat, Fish, Dairy Products, Eggs and Risk of Ischemic Heart Disease: A Prospective Study of 7198 Incident Cases Among 409,885 Participants in the Pan-European EPIC Cohort. Circulation, 2019. 18;139(25):2835-2845.
- Qin, et al. Associations of egg consumption with cardiovascular disease in a cohort study of 0.5 million Chinese adults. Heart 2018;104(21):1756–63