Unpacking JAMA Study’s Findings on Eggs and Heart Disease

In recent years, there has been a growing perception that eggs and dietary cholesterol aren’t as bad as we once thought. But a March 2019 study calls this into question.

The study, published by renowned medical journal JAMA, included 29,615 people who were followed for a median 17.5 years. The authors evaluated whether egg intake or dietary cholesterol was linked to a higher risk of cardiovascular disease or death from any cause.

Their findings? The more eggs or cholesterol that participants consumed, the higher their risk of cardiovascular disease or death from any cause; there was a clear dose-response.

Specifically, each additional half of an egg per day was associated with a 6% increased risk of cardiovascular disease and an 8% increased risk of death over the course of the study. The risks were even more dramatic in women—13% higher risk of cardiovascular disease and 16% higher risk of death for each additional half an egg per day.

Each additional 300 milligrams of dietary cholesterol per day (1 egg contains about 186 milligrams of cholesterol) was linked to a 17% increased risk of cardiovascular disease and an 18% increased risk of death from any cause (not to mention a 14% higher risk of heart failure and a 26% higher risk of stroke). Again, the risk was magnified in women (28% higher risk of death from any cause).

What about people eating a diet that was healthy overall, with lots of fruits and vegetables? Notably, even these participants experienced a significantly higher risk of cardiovascular disease when they had an additional half an egg per day.

Of course, correlation does not equal causation, but these findings include adjustment for many variables and potential confounders, including age, sex, race, education, smoking, physical activity, and other dietary choices, and remained significant even after authors controlled for diabetes, body mass index, blood pressure, blood cholesterol, and other cardiovascular risk factors.

Bottom line: We have no biological requirement to consume cholesterol or eggs; indeed, this large study (among others) suggests that we are better off when we avoid them. Our bodies can make all the cholesterol we need, and we can get other nutrients found in eggs from healthier sources.