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 The report, combining data from six earlier studies, found a 6
percent increased risk of cardiovascular disease when the average
number of eggs consumed per day went up by half an egg.
"The take home message is that individuals who consume higher levels
of dietary cholesterol are at increased risk for the development of
heart disease and mortality later in life," said study coauthor
Norrina Allen, an associate professor of preventive medicine at
Northwestern University's Feinberg School of Medicine in Chicago.
"And in the U.S. diet, eggs are one of the top sources of
cholesterol."
Still, Allen isn't ready to tell everyone to go cold turkey on eggs.
"I'm not advocating people take them completely out of their diets,"
she said. "I'm just suggesting that people eat them in moderation."
It can be hard to translate the association between eggs and heart
disease into advice, Allen allowed. That's because we don't all deal
with cholesterol in the same way, she said. "The amount of
cholesterol you consume isn't linked in a straightforward way with
the amount found in your blood," Allen explained. "That depends on a
lot of factors including your genes and how you metabolize
cholesterol."
Allen's team analyzed data pooled from six studies involving a total
of 29,615 people who were followed for a median of 17.5 years,
according to the report in JAMA. At the start, participants filled
in questionnaires detailing the foods they ate. They were not asked
about their diets again.
Over time, there were 5,400 cardiovascular-related adverse outcomes,
including 2,088 fatal and non-fatal heart disease events, 1,302
fatal and non-fatal stroke events, 1,897 fatal and non-fatal heart
failure events and 113 other cardiovascular disease deaths.
When they analyzed the data, the researchers found an association
between egg consumption as reported at the start of the study and
participants' risk of developing cardiovascular disease. As their
egg consumption rose, so did their risk.
The association was weakened to the point that it was no longer
statistically significant when researchers accounted for total
cholesterol consumption. That, Allen said, means the association
between eggs and heart disease is explained by the cholesterol in
the eggs.
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Other experts weren't entirely convinced that the study shows that
eggs were causing heart disease.
Cholesterol's role in the development of heart disease has been
discussed for more than three decades, said Dr. Dennis Bruemmer, a
cardiologist with the Heart and Vascular Institute and an associate
professor of medicine at the University of Pittsburgh Medical
Center. "The particular contribution of cholesterol derived from
eggs has also been studied in several studies, with varying and
discrepant results," Bruemmer said. "This study does have clear
limitations, including self-reporting at a single time point. This
limits its validity."
While eggs contain quite a bit of cholesterol - about 200 mg, the
maximum daily amount recommended in current guidelines - "eggs in
moderation are probably acceptable from a nutritional standpoint,"
Bruemmer said in an email. Moderation, he added, is "less than one
egg a day on average, including eggs in foods such as bread."
Dr. Holly Andersen agrees that the study has "real limitations."
"It's not good science," said Andersen, a preventive cardiologist
and director of education and outreach at the Ronald O. Perelman
Heart Institute at the NewYork-Presbyterian/Weill Cornell Medical
Center and an associate professor of clinical medicine at Weill
Cornell Medicine.
A big issue for Andersen is that fact that a lot of the egg-eating
participants also appeared to be consuming "large amounts of meats
and processed meats," she said. "If you're consuming a huge amount
of processed meats, it doesn't matter how many eggs you're eating."
Moreover, Andersen said, the study is observational, which means it
can only show there's an association between egg consumption and
heart disease but it can't prove eggs are the culprit. It may just
be that the people eating a lot of eggs are also consuming a lot of
bacon, Andersen said.
That said, the study does have the strength of large numbers,
Andersen said. "More than 29,500 patients is a lot and the follow-up
of 17.5 years is also a lot," she added. "That means we should at
least be looking at the conclusions."
SOURCE: http://bit.ly/2TGrzTO JAMA, online March 15, 2019.
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