American Journal of Clinical Nutrition, Vol. 75, No. 2, 333-334, February 2002
© 2002 American Society for Clinical Nutrition

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Eggs and heart disease risk: perpetuating the misperception
Donald J McNamara
Egg Nutrition Center 1050 17th Street, NW Suite 560 Washington, DC 20036 E-mail: enc~enc-online.org

Conclusion:

The fact that no studies in the past decade have reported a significant relation between either egg consumption or dietary cholesterol intakes and heart disease risk (5) is consistent with the view that the hypothesis that dietary cholesterol is a risk factor for heart disease should be dismissed. A small, statistically significant increase in the ratio of total to HDL cholesterol has little biological importance concerning heart disease risk when considered relative to those dietary and lifestyle factors that do in fact contribute to heart disease risk. Concerning the suggestion by Weggeman et al that eggs make no important contributions to the diet, I refer them to a recent supplement of the Journal of the American College of Nutrition (10) in which the merits of egg consumption are documented. In an evaluation of the relation between dietary cholesterol and the risk of heart disease, it is crucial to not only have accurate estimates of risk but also a practical perspective of what a risk estimate represents.

Bibliography
10. McNamara DJ, ed. Where would we be without the egg? A conference about nature's original functional food. J Am Coll Nutr, 2000;19:495S–562S.

JAMA 1999 Apr 21;281(15):1387-94

A prospective study of egg consumption and risk of cardiovascular disease in men and women.

Hu FB, Stampfer MJ, Rimm EB, Manson JE, Ascherio A, Colditz GA, Rosner BA, Spiegelman D, Speizer FE, Sacks FM, Hennekens CH, Willett WC.

Department of Nutrition, Harvard School of Public Health, Boston, Mass 02115, USA. Frank.hu~channing.harvard.edu

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 37851 men aged 40 to 75 years at study outset and 80082 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 > or =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 > or =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 [the maximum consumption for this study] 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.

Comment in:
J Am Coll Nutr. 2001 Feb;20(1):93-4.

The impact of egg limitations on coronary heart disease risk: do the numbers add up?

McNamara DJ.

Egg Nutrition Center, Washington, DC 20036, USA. enc~enc-online.org

For over 25 years eggs have been the icon for the fat, cholesterol and caloric excesses in the American diet, and the message to limit eggs to lower heart disease risk has been widely circulated. The "dietary cholesterol equals blood cholesterol" view is a standard of dietary recommendations, yet few consider whether the evidence justifies such restrictions. Over 50 years of cholesterol-feeding studies show that dietary cholesterol does have a small effect on plasma cholesterol concentrations. The 167 cholesterol feeding studies in over 3,500 subjects in the literature indicate that a 100 mg change in dietary cholesterol changes plasma total cholesterol by 2.2 mg/dL. Today we recognize that dietary effects on plasma cholesterol must be viewed from effects on the atherogenic LDL cholesterol as well as anti-atherogenic HDL cholesterol since the ratio of LDL:HDL cholesterol is a major determinant of heart disease risk. Cholesterol feeding studies demonstrate that dietary cholesterol increases both LDL and HDL cholesterol with little change in the LDL:HDL ratio. Addition of 100 mg cholesterol per day to the diet increases total cholesterol with a 1.9 mg/dL increase in LDL cholesterol and a 0.4 mg/dL increase in HDL cholesterol. On average, the LDL:HDL ratio change per 100 mg/day change in dietary cholesterol is from 2.60 to 2.61, which would be predicted to have little effect on heart disease risk. These data help explain the epidemiological studies showing that dietary cholesterol is not related to coronary heart disease incidence or mortality across or within populations.