Abstract

Background and purpose: It has long been recommended that patients at risk of cardiovascular events limit their intake of dietary cholesterol to <200 mg/day. One large egg yolk contains more than 200mg of cholesterol, and also contains 250mg of phosphatidylcholine, which is converted by intestinal bacterial to trimethylamine. In the face of increasingly widespread belief that consumption of dietary cholesterol and eggs is harmless, we analyzed the effects of these dietary constituents on mortality and cardiovascular outcomes in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study population. Methods: A longitudinal cohort study of 30,239 community-dwelling black and white individuals aged 45+ years, recruited between January 2003 and October 2007 from the 48 contiguous states. The study oversampled black participants (44%), and residents of the southeastern “stroke belt” (56%). We analyzed total mortality and atherosclerotic events (ischemic stroke, myocardial infarction and revascularization) after 4.9 (SD 1.7) years of followup. Hazard ratios were computed for egg consumption and cholesterol consumption by quartiles, adjusted for race, age, sex, income, education, region, dyslipidemia, exercise, hypertension, diabetes, smoking, atrial fibrillation and caloric intake. Results: As shown in the table, there was a dose-related increase in all-cause mortality and atherosclerotic events with both cholesterol intake and egg consumption. Conclusions: Recommendations to limit the intake of cholesterol remain good advice for patients at risk of cardiovascular events. As one large egg yolk contains more than the daily recommended intake of cholesterol, egg yolk consumption should also be limited.

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