Abstract
Background
Increasingly the potential harm from high cholesterol intake, and specifically from
egg yolks, is considered insignificant. We therefore assessed total plaque area (TPA)
in patients attending Canadian vascular prevention clinics to determine if the atherosclerosis
burden, as a marker of arterial damage, was related to egg intake. To provide perspective
on the magnitude of the effect, we also analysed the effect of smoking (pack-years).
Methods
Consecutive patients attending vascular prevention clinics at University Hospital
had baseline measurement of TPA by duplex ultrasound, and filled out questionnaires
regarding their lifestyle and medications, including pack-years of smoking, and the
number of egg yolks consumed per week times the number of years consumed (egg-yolk
years).
Results
Data were available in 1262 patients; mean (SD) age was 61.5 (14.8) years; 47% were
women. Carotid plaque area increased linearly with age after age 40, but increased
exponentially with pack-years of smoking and with egg-yolk years. Plaque area in patients
consuming <2 eggs per week (n = 388) was 125 ± 129 mm2, versus 132 ± 142 mm2 in those consuming 3 or more eggs per week (n = 603); (p < 0.0001 after adjustment for age). In multiple regression, egg-yolk years remained
significant after adjusting for coronary risk factors.
Interpretation
Our findings suggest that regular consumption of egg yolk should be avoided by persons
at risk of cardiovascular disease. This hypothesis should be tested in a prospective
study with more detailed information about diet, and other possible confounders such
as exercise and waist circumference.
Highlights
- Carotid total plaque area (TPA) increases linearly with age.
- TPA increases exponentially with smoking pack-years.
- TPA increases exponentially with egg-yolk years.
- The effect size of egg yolks appears to be approximately 2/3 that of smoking.
- Probably egg yolks should be avoided by persons at risk of vascular disease.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
PDF Download and 24 Hours Online AccessSubscribe:
Subscribe to AtherosclerosisAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) general cardiovascular risk profile for use in primary care: the Framingham heart study.J Am Med Assoc. 2001 May 16; 285: 2486-2497
- Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease.Am J Clin Nutr. 2010 Mar; 91: 535-546
- Revisiting dietary cholesterol recommendations: does the evidence support a limit of 300 mg/d?.Curr Atheroscler Rep. 2010 Nov; 12: 377-383
- Increased dietary cholesterol does not increase plasma low density lipoprotein when accompanied by an energy-restricted diet and weight loss.Eur J Nutr. 2008 Sep; 47: 287-293
- The influence of egg consumption on the serum cholesterol level in human subjects.Am J Clin Nutr. 1977 May; 30: 664-673
- A double-blind, randomized, controlled trial of the effects of two eggs per day in moderately hypercholesterolemic and combined hyperlipidemic subjects taught the NCEP step I diet.J Am Coll Nutr. 1997 Dec; 16: 551-561
- Increases in dietary cholesterol are associated with modest increases in both LDL and HDL cholesterol in healthy young women.Arterioscler Thromb Vasc Biol. 1995 Feb; 15: 169-178
- A dose-response study of the effects of dietary cholesterol on fasting and postprandial lipid and lipoprotein metabolism in healthy young men.Arterioscler Thromb. 1994 Apr; 14: 576-586
- Egg consumption and endothelial function: a randomized controlled crossover trial.Int J Cardiol. 2005 Mar 10; 99: 65-70
- Daily egg consumption in hyperlipidemic adults–effects on endothelial function and cardiovascular risk.Nutr J. 2010; 9: 28
- A prospective study of egg consumption and risk of cardiovascular disease in men and women.J Am Med Assoc. 1999 Apr 21; 281: 1387-1394
- Eggs, serum cholesterol, and coronary heart disease.Am J Clin Nutr. 1982 Oct; 36: 617-625
- Egg consumption in relation to cardiovascular disease and mortality: the physicians' health study.Am J Clin Nutr. 2008 Apr; 87: 964-969
- Egg consumption and risk of heart failure in the physicians' health study.Circulation. 2008 Jan 29; 117: 512-516
- Dietary cholesterol and egg yolks: not for patients at risk of vascular disease.Can J Cardiol. 2010 Nov; 26: e336-e339
- Fasting lipids: the carrot in the snowman.Can J Cardiol. 2003; 19: 890-892
- Technology insight: ultrasound measurement of carotid plaque–patient management, genetic research, and therapy evaluation.Nat Clin Pract Neurol. 2006 Nov; 2: 611-619
- Treating arteries instead of risk factors. A paradigm change in management of atherosclerosis.Stroke. 2010 Apr 22; 41: 1193-1199
- Carotid plaque area: a tool for targeting and evaluating vascular preventive therapy.Stroke. 2002; 33: 2916-2922
- An approach to ascertain probands with a non traditional risk factor for carotid atherosclerosis.Atherosclerosis. 1999; 144: 429-434
- Extremes of unexplained variation as a phenotype: an efficient approach for genome-wide association studies of cardiovascular disease.Circ Cardiovasc Genet. 2010 Apr; 3: 215-221
- Serum cholesterol response to dietary cholesterol.Am J Clin Nutr. 1984 Aug; 40: 351-359
- Quantitative effects of dietary fat on serum cholesterol in man.Am J Clin Nutr. 1965 Nov; 17: 281-295
- Dietary cholesterol from eggs increases the ratio of total cholesterol to high-density lipoprotein cholesterol in humans: a meta-analysis.Am J Clin Nutr. 2001 May; 73: 885-891
- Egg consumption, serum cholesterol, and cause-specific and all-cause mortality: the national integrated project for prospective observation of non-communicable disease and its trends in the aged, 1980 (NIPPON DATA80).Am J Clin Nutr. 2004 Jul; 80: 58-63
- Effect of egg yolk feeding on the concentration and composition of serum lipoproteins in man.Atherosclerosis. 1985 Feb; 54: 157-166
- Effects of dietary fat and fatty acids on coronary artery disease risk and total and lipoprotein cholesterol concentrations: epidemiologic studies.Am J Clin Nutr. 1997 May; 65: 1597S-1610S
- Cholesterol intake and plasma cholesterol: an update.J Am Coll Nutr. 1997; 16: 530-534
- Dietary cholesterol from eggs increases plasma HDL cholesterol in overweight men consuming a carbohydrate-restricted diet.J Nutr. 2008 Feb; 138: 272-276
- Pre-menopausal women, classified as hypo- or hyperresponders, do not alter their LDL/HDL ratio following a high dietary cholesterol challenge.J Am Coll Nutr. 2002 Jun; 21: 250-258
- Apolipoprotein E polymorphism and atherosclerosis.Arteriosclerosis. 1988 Jan; 8: 1-21
- ABC transporters and sterol absorption.Curr Drug Targets Cardiovasc Haematol Disord. 2005 Feb; 5: 31-37
- Phenotypic heterogeneity of sitosterolemia.J Lipid Res. 2004 Dec; 45: 2361-2367
- The ABCG5 polymorphism contributes to individual responses to dietary cholesterol and carotenoids in eggs.J Nutr. 2006 May; 136: 1161-1165
- Cholesterol absorption efficiency declines at moderate dietary doses in normal human subjects.J Lipid Res. 1999 Aug; 40: 1453-1458
- Dietary cholesterol feeding suppresses human cholesterol synthesis measured by deuterium incorporation and urinary mevalonic acid levels.Arterioscler Thromb Vasc Biol. 1996 Oct; 16: 1222-1228
- Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies.Br Med J. 1997 Jan 11; 314: 112-117
- Regular egg consumption does not increase the risk of stroke and cardiovascular diseases.Med Sci Monit. 2007 Jan; 13: CR1-CR8
- Diet and physical activity in relation to overall mortality amongst adult diabetics in a general population cohort.J Intern Med. 2006 Jun; 259: 583-591
- Egg consumption and risk of type 2 diabetes in men and women.Diabetes Care. 2009 Feb; 32: 295-300
- Carotid atherosclerosis is a stronger predictor of myocardial infarction in women than in men: a 6-year follow-up study of 6226 persons: the Tromso Study.Stroke. 2007 Nov; 38: 2873-2880
- Carotid plaque, compared with carotid intima-media thickness, more accurately predicts coronary artery disease events: a meta-analysis.Atherosclerosis. 2011 Jun 18; 220: 128-133
- Low-carbohydrate-diet score and the risk of coronary heart disease in women.N Engl J Med. 2006 Nov 9; 355: 1991-2002
- Low-carbohydrate-diet score and risk of type 2 diabetes in women.Am J Clin Nutr. 2008 Feb; 87: 339-346
- The effect of a plant-based low-carbohydrate (“Eco-Atkins”) diet on body weight and blood lipid concentrations in hyperlipidemic subjects.Arch Intern Med. 2009 Jun 8; 169: 1046-1054
- Mediterranean diet and public health: personal reflections.Am J Clin Nutr. 1995 Jun; 61: 1321S-1323S
Article Info
Publication History
Published online: August 10, 2012
Accepted:
July 18,
2012
Received in revised form:
July 17,
2012
Received:
February 11,
2012
Identification
Copyright
© 2012 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Regular consumption of eggs does not affect carotid plaque area or risk of acute myocardial infarction in Finnish menAtherosclerosisVol. 227Issue 1
- PreviewThe research article recently published by Spence et al. [1] reported increased carotid plaque area in individuals consuming 3 or more eggs per week. Based on their findings, the authors suggested that persons at risk of cardiovascular diseases should avoid regular consumption of egg yolk. The article also discussed the effects of smoking on cardiovascular health. In the public media, the study gained immediate publicity worldwide, and the results were taken even as evidence for consumption of eggs being equally dangerous with smoking to one's cardiovascular health [2].
- Full-Text
- Preview
- Egg consumption and coronary disease: Letter to the editor regarding Chagas P, Caramori P, Galdino TP, Barcellos CS, Gomes I, Schwanke CH. Egg consumption and coronary atherosclerotic burden. Atherosclerosis 2013 August;229(2):381–4AtherosclerosisVol. 231Issue 2
- PreviewIn their recent study, Chagas et al. [1] assessed current egg consumption in patients undergoing coronary angiography. They divided patients into those consuming less than one egg per week, one per week and more than one per week, and found that patients with coronary artery disease had a lower consumption of eggs than did patients without coronary disease. The most likely explanation for their finding was that patients with coronary artery disease will adopt a healthier lifestyle.
- Full-Text
- Preview
- Egg on their faces (probably not in their necks); The yolk of the tenuous cholesterol-to-plaque conclusionAtherosclerosisVol. 227Issue 1
- Putting eggs and cigarettes in the same basket; are you yolking?AtherosclerosisVol. 227Issue 1
- PreviewDr. Spence and colleagues (2012) completed a retrospective cohort study, using patient questionnaire and total plaque area (TPA) data from a vascular disease prevention database [1]. They aimed to address whether egg yolk intake relates to vascular damage. There was no stated hypothesis. It was determined that “the effect of the upper quintile of egg consumption was equivalent in terms of atheroma development to 2/3 the effect of the upper quintile of smoking”.
- Full-Text
- Preview
