Eggs and Heart Disease: New study in line with broader science

Mickey Circulation Blog

A new study published last week in the American Heart Association journal Circulation adds more data to the mix on egg consumption and risk for heart disease1. Recall just a few weeks ago, a study published in the Journal of the American Medical Association (JAMA) made headlines when it seemed to reverse the course of the latest dietary recommendations to say that, once again, eggs and dietary cholesterol were linked with increased heart disease risk2. Now, just a few weeks later a new study says exactly the opposite.

In the new study, researchers from Oxford University in the U.K. analyzed data from over 400,000 men and women in Europe over an average follow up of 12 years. The authors reported a small but statistically significant decrease in risk for ischemic heart disease with every 20 gram increment of egg intake (about ½ an egg per day). The researchers also reported similar favorable results for yogurt and cheese consumption, while consumption of red and processed meats was associated with increased risk for heart disease.

Does this mean the science on eggs has changed yet again, just within a matter of weeks? No, it doesn’t. What it does mean is that the science never actually changed with the publication of the study in JAMA. As with any study, it is important to not view it in isolation, but rather in the broader context of the total scientific literature. This is particularly true with studies that are observational in nature, because in this type of research there are often outlier studies that deviate from the clear majority.

Furthermore, if you read the details of the new study the authors rightly pointed out that, as with any new observational study, there are several important factors to consider when interpreting these results:

  • The beneficial associations eggs and yogurt may be influenced by reverse causation bias.
  • There will always be residual confounding in observational studies that cannot be eliminated; even though the investigators statistically adjusted for many potential confounders including lifestyle factors.
  • The results may not be generalizable to populations outside this European cohort.
  • Associations with eggs and yogurt were no longer significant after excluding the first 4 years of follow-up.

Importantly, these are factors that should be considered in any observational study, whether the results are favorable or unfavorable to a dietary or lifestyle factor.

That said, these latest findings published in Circulation are more in line with previous meta-analyses of observational cohorts that reported either no relationship with egg consumption and cardiovascular risk3,4 or small decreases in cardiovascular risk5. Given all the caveats and confounding factors that are involved in observational studies, consistency across many studies over time is important.

It’s easy to get wrapped up in the day to day headlines from the next big study, and view the latest study as the next “game changer”. But the truth is science doesn’t change all that quickly, especially nutrition science. Many studies over the course of years or even decades are needed to achieve consensus. This is in fact what happened when the 2015 Dietary Guidelines for Americans no longer listed dietary cholesterol as a nutrient of concern. The evidence required to do so involved 16 studies over the course of many years3.

Lastly, as these studies are all observational in nature it is important to remember that we cannot infer a cause and effect relationship, no matter if the result is favorable or unfavorable to heart disease risk.  Therefore, it is important to view these results in the context of existing randomized controlled trials that consistently show egg intake does not negatively impact cardiovascular disease risk factors, and in some cases, has shown to improve risk factors such as HDL, or “good” cholesterol6.

 

References

  1. Key et al. Consumption of Meat, Fish, Dairy Products, Eggs and Risk of Ischemic Heart Disease: A Prospective Study of 7198 Incident Cases Among 409,885 Participants in the Pan-European EPIC Cohort. Circulation. 2019 Apr 22. [Epub ahead of print]
  2. Zhong et al. Associations of dietary cholesterol or egg consumption with incident cardiovascular disease and mortality. JAMA. 2019;321(11):1081-1095.
  3. Shin JY, Xun P, Nakamura Y, He K. Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis. Am J Clin Nutr. 2013 Jul;98(1):146-59.
  4. Rong Y, Chen L, Zhu T, Song Y, Yu M, Shan Z, Sands A, Hu FB, Liu L. Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies. BMJ. 2013 Jan 7;346:e8539.
  5. Alexander DD, et. al. Meta-analysis of egg consumption and risk of coronary heart disease and stroke. J Am Coll Nutr. 2016. 6:1-13.
  6. Blesso CN, Fernandez ML. Dietary Cholesterol, Serum Lipids, and Heart Disease: Are Eggs Working for or Against You? Nutrients. 2018 Mar 29;10(4). pii: E426. doi: 10.3390/nu10040426. Review.