Egg consumption and risk of cardiovascular disease: three large prospective US cohort studies, systematic review, and updated meta-analysis - PubMed (original) (raw)

Meta-Analysis

Egg consumption and risk of cardiovascular disease: three large prospective US cohort studies, systematic review, and updated meta-analysis

Jean-Philippe Drouin-Chartier et al. BMJ. 2020.

Abstract

Objective: To evaluate the association between egg intake and cardiovascular disease risk among women and men in the United States, and to conduct a meta-analysis of prospective cohort studies.

Design: Prospective cohort study, and a systematic review and meta-analysis of prospective cohort studies.

Setting: Nurses' Health Study (NHS, 1980-2012), NHS II (1991-2013), Health Professionals' Follow-Up Study (HPFS, 1986-2012).

Participants: Cohort analyses included 83 349 women from NHS, 90 214 women from NHS II, and 42 055 men from HPFS who were free of cardiovascular disease, type 2 diabetes, and cancer at baseline.

Main outcome measures: Incident cardiovascular disease, which included non-fatal myocardial infarction, fatal coronary heart disease, and stroke.

Results: Over up to 32 years of follow-up (>5.54 million person years), 14 806 participants with incident cardiovascular disease were identified in the three cohorts. Participants with a higher egg intake had a higher body mass index, were less likely to be treated with statins, and consumed more red meats. Most people consumed between one and less than five eggs per week. In the pooled multivariable analysis, consumption of at least one egg per day was not associated with incident cardiovascular disease risk after adjustment for updated lifestyle and dietary factors associated with egg intake (hazard ratio for at least one egg per day v less than one egg per month 0.93, 95% confidence interval 0.82 to 1.05). In the updated meta-analysis of prospective cohort studies (33 risk estimates, 1 720 108 participants, 139 195 cardiovascular disease events), an increase of one egg per day was not associated with cardiovascular disease risk (pooled relative risk 0.98, 95% confidence interval 0.93 to 1.03, I2=62.3%). Results were similar for coronary heart disease (21 risk estimates, 1 411 261 participants, 59 713 coronary heart disease events; 0.96, 0.91 to 1.03, I2=38.2%), and stroke (22 risk estimates, 1 059 315 participants, 53 617 stroke events; 0.99, 0.91 to 1.07, I2=71.5%). In analyses stratified by geographical location (P for interaction=0.07), no association was found between egg consumption and cardiovascular disease risk among US cohorts (1.01, 0.96 to 1.06, I2=30.8%) or European cohorts (1.05, 0.92 to 1.19, I2=64.7%), but an inverse association was seen in Asian cohorts (0.92, 0.85 to 0.99, I2=44.8%).

Conclusions: Results from the three cohorts and from the updated meta-analysis show that moderate egg consumption (up to one egg per day) is not associated with cardiovascular disease risk overall, and is associated with potentially lower cardiovascular disease risk in Asian populations.

Systematic review registration: PROSPERO CRD42019129650.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi\_disclosure.pdf and declare: support from the National Institutes of Health and Canadian Institutes of Health Research for the submitted work; JPDC received speaker and consulting honorariums from the Dairy Farmers of Canada, outside the submitted work; YL received grants from California Walnut Commission, outside the submitted work; FBH received research support from the California Walnut Commission and honorariums for lectures from Metagenics and Standard Process and honorariums from Diet Quality Photo Navigation, outside the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1

Fig 1

Association of egg consumption with cardiovascular disease risk for one egg per day increase using random effects meta-analysis. Weights of each estimate are represented by size of square. Hollow squares represent individual estimate effects and solid lines represent 95% confidence intervals. Overall effect estimate and 95% confidence interval are represented by diamond and dotted line. I2 refers to proportion of heterogeneity among studies. CHD=coronary heart disease; CVD=cardiovascular disease; HPFS=Health Professionals’ Follow-Up Study; i-stroke=ischemic stroke; NHS=Nurses’ Health Study; T2D=type 2 diabetes

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