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Abstract
The relationship between blood cholesterol and heart disease is well-established, with the lowering of serum low-density lipoprotein (LDL)-cholesterol being the primary target of preventive therapy. Furthermore, epidemiological studies report lower risk for heart disease with higher concentrations of high-density lipoprotein (HDL)-cholesterol. There has also been considerable interest in studying the relationship between dietary cholesterol intake and heart disease risk. Eggs are one of the richest sources of cholesterol in the diet. However, large-scale epidemiological studies have found only tenuous associations between the intake of eggs and cardiovascular disease risk. Well-controlled, clinical studies show the impact of dietary cholesterol challenges via egg intake on serum lipids is highly variable, with the majority of individuals (~2/3 of the population) having only minimal responses, while those with a significant response increase both LDL and HDL-cholesterol, typically with a maintenance of the LDL/HDL cholesterol ratio. Recent drug trials targeting HDL-cholesterol have been unsuccessful in reducing cardiovascular events, and thus it is unclear if raising HDL-cholesterol with chronic egg intake is beneficial. Other important changes with egg intake include potentially favorable effects on lipoprotein particle profiles and enhancing HDL function. Overall, the increased HDL-cholesterol commonly observed with dietary cholesterol feeding in humans appears to also coincide with improvements in other markers of HDL function. However, more investigation into the effects of dietary cholesterol on HDL functionality in humans is warranted. There are other factors found in eggs that may influence risk for heart disease by reducing serum lipids, such as phospholipids, and these may also modify the response to dietary cholesterol found in eggs. In this review, we discuss how eggs and dietary cholesterol affect serum cholesterol concentrations, as well as more advanced lipoprotein measures, such as lipoprotein particle profiles and HDL metabolism.
Highlights
Cardiovascular disease (CVD) contributes to more than 17 million deaths per year globally, which accounts for nearly half of all deaths from non-communicable diseases [1]
Similar responses were observed in hyperlipidemic adults; consuming two eggs per day resulted in elevated high-density lipoprotein (HDL)-C without a change in low-density lipoprotein (LDL)-C in hypercholesterolemic adults, while there was an increase in both low-density lipoprotein -cholesterol (LDL-C) and high-density lipoprotein-cholesterol (HDL-C) in combined hyperlipidemics [49]
Chronic daily egg intake does increase LDL-C to a certain extent in individuals classified as hyper-responders
Summary
Cardiovascular disease (CVD) contributes to more than 17 million deaths per year globally, which accounts for nearly half of all deaths from non-communicable diseases [1]. The Framingham Heart Study was one of the first studies to show a relationship between serum cholesterol and heart disease, and it was hypothesized that dietary cholesterol was a modifier of heart disease through effects on serum lipids, even though no such association was observed at the time [6,7]. This hypothesis was consistent with evidence from animal studies, such as the seminal work by Nikolai N. Dietary cholesterol intake was not found to be significantly associated with either heart disease, ischemic stroke, or hemorrhagic stroke
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