How does egg consumption affect the risk of heart disease?

Egg Consumption and Heart Disease Risk

For healthy adults without diabetes or dyslipidemia, consuming up to one egg daily does not increase cardiovascular disease risk and can be safely incorporated into a heart-healthy diet. 1, 2

Evidence-Based Recommendations by Population

Healthy Adults (No Diabetes or Dyslipidemia)

• Up to 1 egg per day is safe and shows no association with increased risk of coronary heart disease (CHD), cardiovascular disease (CVD) incidence, or mortality in multiple meta-analyses of prospective cohort studies. 1, 2

• The 2022 European Society of Cardiology guidelines explicitly state that 1 egg daily is not associated with increased CVD risk in people without diabetes and dyslipidemia. 1

• This recommendation is supported by the American Heart Association's dietary pattern guidelines, which allow eggs as part of a balanced diet when consumed in moderation. 1, 2

High-Risk Populations (Diabetes or Dyslipidemia)

• Limit egg consumption to 3 eggs per week maximum in patients with diabetes or hyperlipidemia. 2

• Frequent egg consumers (7+ eggs/week) with diabetes experience higher rates of clinical CVD events compared to those consuming fewer eggs. 2

• The restriction is necessary because these populations show amplified cardiovascular risk with higher egg intake, despite eggs being neutral in healthy individuals. 2

Dietary Context Matters

Saturated Fat Intake Modifies Risk

• If the overall diet is high in saturated fats, restrict eggs to 3 per week regardless of metabolic status. 2

• The plasma cholesterol response to dietary cholesterol is amplified when combined with high saturated fat intake and low fiber content. 2

• When eggs are consumed within a Mediterranean or plant-based dietary pattern (low in saturated fat), up to 1 egg daily remains safe. 2

Food Matrix Considerations

• Eggs should be viewed in the context of overall dietary patterns rather than as an isolated nutrient source. 1, 2

• Eggs are positioned as a neutral food choice—healthier than processed meats and refined grains, but less beneficial than fish, nuts, legumes, and fruits. 2

• The American Heart Association recommends preferring fish, legumes, and plant-based proteins over eggs when possible, though eggs remain acceptable in moderation. 1

Cholesterol and Lipid Effects

Modest Impact on Blood Cholesterol

• A 100 mg change in dietary cholesterol (approximately half an egg) changes plasma total cholesterol by only 2.2 mg/dL. 3

• Dietary cholesterol increases both LDL and HDL cholesterol with minimal change in the LDL:HDL ratio, which is the key determinant of heart disease risk. 3

• Adding 100 mg cholesterol per day increases LDL by 1.9 mg/dL and HDL by 0.4 mg/dL, resulting in a negligible change in the LDL:HDL ratio (from 2.60 to 2.61). 3

Individual Variation Exists

• Some individuals are "hyper-responders" to dietary cholesterol and may experience larger increases in LDL cholesterol. 2

• For known hyper-responders, consider limiting egg consumption to 3-6 eggs per week even if otherwise healthy. 2

• The 2015 Dietary Guidelines removed the 300 mg/day cholesterol limit for the general population, though some individuals with elevated LDL-C may still benefit from reduced egg yolk intake. 1

Clinical Decision Algorithm

Step 1: Assess Metabolic Status

• No diabetes and no dyslipidemia → Proceed to Step 2 2
• Diabetes or dyslipidemia present → Maximum 3 eggs per week 2

Step 2: Evaluate Overall Dietary Pattern

• Mediterranean or plant-based diet (low saturated fat) → Up to 1 egg daily 2
• Western diet high in saturated fats → Maximum 3 eggs per week 2

Step 3: Consider Individual Cholesterol Response (if known)

• Normal responder → Follow Step 2 recommendations 2
• Hyper-responder → Limit to 3-6 eggs per week 2

Common Pitfalls to Avoid

• Don't focus solely on egg yolks while ignoring overall dietary quality. The foods consumed alongside eggs (processed meats, refined grains, saturated fats) have greater impact on CVD risk than eggs themselves. 4, 5

• Don't apply blanket restrictions to healthy populations. Historical recommendations limiting eggs to 2-4 per week for everyone were based on oversimplified views of dietary cholesterol and are not supported by current evidence. 6, 4

• Don't ignore preparation methods. Eggs fried in butter or served with bacon and sausage create a very different cardiovascular risk profile than eggs poached or scrambled with vegetables. 1, 2

• Don't forget that two egg whites contain the same protein as 1 oz of meat without the cholesterol. This is a useful alternative for patients requiring cholesterol restriction. 1