Eggs, Cholesterol and Heart Health

Overview

Dietary advice on eggs, cholesterol and heart health has evolved over the years. Earlier recommendations to limit egg intake as a way to reduce blood cholesterol and heart disease risk were based on studies using much higher cholesterol intakes than typically consumed and statistical analysis wasn’t sophisticated enough to account for the confounding effect of saturated fat, often consumed together with foods high in dietary cholesterol.

Current evidence using more advanced analysis and a greater body of research indicates that, for most people, dietary cholesterol has little to no impact on blood cholesterol levels or heart disease risk and eggs can be included as part of a healthy dietary pattern.

Cardiovascular Disease in Australia

Cardiovascular disease (CVD) remains a leading health concern in Australia (1):

• 1 in 6 Australians live with CVD
• 1 in 3 adults have elevated blood cholesterol levels
• CVD is the leading cause of disease burden for men, and sixth for women

While elevated LDL cholesterol levels are one risk factor for CVD, overall risk is influenced by multiple factors. These include diet quality, physical activity, body weight, smoking, alcohol intake and genetics.

Importantly, overall dietary patterns, rather than single nutrients such as cholesterol, are now recognised as the key drivers of cardiovascular risk (2).

Dietary Patterns and Heart Health

National and international guidelines emphasise dietary patterns that prioritize the inclusion of whole foods, for example the Mediterranean and DASH diets, as a strategy to reduce CVD risk.

These patterns are characterised by:

• High intake of vegetables, fruits and wholegrains
• Inclusion of healthy protein sources (including eggs)
• Emphasis on unsaturated fats
• Lower intake of saturated fat, trans fat and added sugars

Dietary cholesterol is no longer a primary focus of most guidelines as it has little to no impact on risk (2).

Dietary Cholesterol, Saturated Fat and Blood Lipids

Consistent evidence shows saturated fat intake has a greater impact on LDL cholesterol levels, in turn a risk factor for CVD, than dietary cholesterol.

A recent Australian randomised controlled trial further confirmed this by comparing the consumption of 2 eggs per day (high dietary cholesterol) within a low saturated fat diet with a high saturated fat diet containing minimal eggs (low dietary cholesterol). After 5 weeks, those on the high egg, low saturated fat diet had lower LDL cholesterol levels compared to those on the high saturated fat, low egg diet.  The authors concluded that saturated fat—not dietary cholesterol—was the primary driver of LDL cholesterol levels (3).

Eggs, Cholesterol and Heart Disease Risk

Eggs contain dietary cholesterol (~398 mg per serve), but are relatively low in saturated fat, and therefore have little to no impact on blood cholesterol levels and CVD risk (4).

Individuals with existing conditions

For people with existing:

• Cardiovascular disease
• Type 2 diabetes
• Elevated LDL cholesterol

The Heart Foundation recommends:

• Up to 7 eggs per week (5)

Additional Considerations

Egg consumption has also been associated with:

• Increased HDL cholesterol (6)
• Larger, less atherogenic LDL particle size (7)
• No detrimental effects in individuals with prediabetes or type 2 diabetes when consumed within a healthy dietary pattern (8).

Eggs also provide:

• Unsaturated fats
• Omega-3 fatty acids
• Lutein and zeaxanthin

These nutrients may play a role in lowering CVD risk, further supporting the value of eggs as part of a nutrient-dense dietary pattern.

Clinical Application

Eggs can be recommended:

• As part of a balanced, heart-healthy dietary pattern
• As a nutrient-dense protein source low in saturated fat
• Without restriction in healthy individuals

For individuals with cardiometabolic conditions:

• Consider overall dietary pattern and saturated fat intake
• Align with Heart Foundation guidance

This statement is for healthcare professionals only.

*One serve = 2x60g eggs (104g edible portion)

As diet-induced changes in total cholesterol and lipoproteins vary considerably between individuals, Australian Eggs recommends individual discussion of the recommendations regarding egg intake with their healthcare professional.

For patient-friendly information about eggs and cholesterol click here.

Useful Links

• Heart Foundation: www.heartfoundation.org.au
• Australian Dietary Guidelines: www.eatforhealth.gov.au/guidelines