Associations of egg and cholesterol intakes with carotid intima-media thickness and risk of incident coronary artery disease according to apolipoprotein E phenotype in men: the Kuopio Ischaemic Heart Disease Risk Factor Study.

BACKGROUND In general populations, the effects of dietary cholesterol on blood cholesterol concentrations are modest. However, the relation is stronger in those with an ɛ4 allele in the apolipoprotein E gene (APOE). There is little information on the association between cholesterol intake and the risk of coronary artery disease (CAD) among those with the ApoE4 phenotype. OBJECTIVE We investigated the associations of intakes of cholesterol and eggs, a major source of dietary cholesterol, with carotid intima-media thickness and the risk of incident CAD in middle-aged and older men from eastern Finland. DESIGN The study included 1032 men aged 42-60 y in 1984-1989 at the baseline examinations of the prospective, population-based Kuopio Ischaemic Heart Disease Risk Factor Study. Data on common carotid artery intima-media thickness (CCA-IMT) were available for 846 men. Dietary intakes were assessed with 4-d food records. Associations with incident CAD and baseline CCA-IMT were analyzed by using Cox regression and ANCOVA, respectively. RESULTS The ApoE4 phenotype was found in 32.5% of the men. During the average follow-up of 20.8 y, 230 CAD events occurred. Egg or cholesterol intakes were not associated with the risk of CAD. Each 1 additional egg (55 g)/d was associated with a multivariable-adjusted HR of 1.17 (95% CI: 0.85, 1.61) in the ApoE4 noncarriers and an HR of 0.93 (95% CI: 0.50, 1.72) in the ApoE4 carriers (P-interaction = 0.34). Each 100-mg/d higher cholesterol intake was associated with an HR of 1.04 (95% CI: 0.89, 1.22) in the ApoE4 noncarriers and an HR of 0.95 (95% CI: 0.73, 1.25) in the ApoE4 carriers (P-interaction = 0.81). Egg or cholesterol intakes were also not associated with increased CCA-IMT. CONCLUSION Egg or cholesterol intakes were not associated with increased CAD risk, even in ApoE4 carriers (i.e., in highly susceptible individuals).

[1]  Salonen Jt.  Is there a continuing need for longitudinal epidemiologic research? The Kuopio Ischaemic Heart Disease Risk Factor Study. , 1988 .

[2]  J. Manson,et al.  A prospective study of egg consumption and risk of cardiovascular disease in men and women. , 1999, JAMA.

[3]  A. Keys,et al.  Serum cholesterol response to changes in the diet: II. The effect of cholesterol in the diet. , 1965, Metabolism: clinical and experimental.

[4]  J. Gaziano,et al.  Egg consumption in relation to cardiovascular disease and mortality: the Physicians' Health Study. , 2008, The American journal of clinical nutrition.

[5]  C. Sing,et al.  Apolipoprotein E polymorphism and atherosclerosis. , 1988, Arteriosclerosis.

[6]  A. Keys,et al.  Serum cholesterol response to changes in the diet: II. The effect of cholesterol in the diet☆ , 1965 .

[7]  H. Nawaz,et al.  Egg consumption and endothelial function: a randomized controlled crossover trial. , 2005, International journal of cardiology.

[8]  A. Lichtenstein,et al.  Gene-diet interaction in determining plasma lipid response to dietary intervention. , 1995, Atherosclerosis.

[9]  Brian J. Bennett,et al.  Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease , 2011, Nature.

[10]  J. Viikari,et al.  Apolipoprotein E Phenotype Regulates Cholesterol Absorption in Healthy 13-Month-Old Children–The STRIP Study , 2001, Pediatric Research.

[11]  M. Fernández,et al.  Eggs distinctly modulate plasma carotenoid and lipoprotein subclasses in adult men following a carbohydrate-restricted diet. , 2010, The Journal of nutritional biochemistry.

[12]  H. Macdonald.  High stored iron levels are associated with excess risk of myocardial infarction in eastern Finnish men. , 1993, Circulation.

[13]  A. Folsom,et al.  Association of serum vitamin levels, LDL susceptibility to oxidation, and autoantibodies against MDA-LDL with carotid atherosclerosis. A case-control study. The ARIC Study Investigators. Atherosclerosis Risk in Communities. , 1997, Arteriosclerosis, thrombosis, and vascular biology.

[14]  J. Spence,et al.  Egg yolk consumption and carotid plaque. , 2012, Atherosclerosis.

[15]  H. Gylling,et al.  Cholesterol absorption and synthesis related to low density lipoprotein metabolism during varying cholesterol intake in men with different apoE phenotypes. , 1992, Journal of lipid research.

[16]  Ji-Young Lee,et al.  Egg Intake during Carbohydrate Restriction Alters Peripheral Blood Mononuclear Cell Inflammation and Cholesterol Homeostasis in Metabolic Syndrome , 2014, Nutrients.

[17]  M. Fernández,et al.  A lutein-enriched diet prevents cholesterol accumulation and decreases oxidized LDL and inflammatory cytokines in the aorta of guinea pigs. , 2011, The Journal of nutrition.

[18]  J M Venäläinen,et al.  Relation of leisure-time physical activity and cardiorespiratory fitness to the risk of acute myocardial infarction. , 1994, The New England journal of medicine.

[19]  J. Salonen,et al.  Is there a continuing need for longitudinal epidemiologic research? The Kuopio Ischaemic Heart Disease Risk Factor Study. , 1988, Annals of clinical research.

[20]  M. Fernández,et al.  Effects of carbohydrate restriction and dietary cholesterol provided by eggs on clinical risk factors in metabolic syndrome. , 2013, Journal of clinical lipidology.

[21]  F. Hu,et al.  Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies , 2013, BMJ.

[22]  D. Panagiotakos,et al.  Dietary choline and betaine intakes in relation to concentrations of inflammatory markers in healthy adults: the ATTICA study. , 2008, The American journal of clinical nutrition.

[23]  E. Vartiainen,et al.  Explaining the 25-year decline of serum cholesterol by dietary changes and use of lipid-lowering medication in Finland , 2010, Public Health Nutrition.

[24]  V. Njike,et al.  Effects of Egg Ingestion on Endothelial Function in Adults with Coronary Artery Disease: A Randomized, Controlled, Crossover Trial , 2013, American heart journal.

[25]  Brian J. Bennett,et al.  Effect of egg ingestion on trimethylamine-N-oxide production in humans: a randomized, controlled, dose-response study. , 2014, The American journal of clinical nutrition.

[26]  J. Dwyer,et al.  Oxygenated Carotenoid Lutein and Progression of Early Atherosclerosis: The Los Angeles Atherosclerosis Study , 2001, Circulation.

[27]  V. Njike,et al.  Daily egg consumption in hyperlipidemic adults - Effects on endothelial function and cardiovascular risk , 2010, Nutrition journal.

[28]  Janusz Wnek,et al.  2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. , 2014, Circulation.

[29]  G. Vogler,et al.  Apolipoprotein E polymorphism in a Danish population compared to findings in 45 other study populations around the world , 1992, Genetic epidemiology.

[30]  C. Sing,et al.  Role of the apolipoprotein E polymorphism in determining normal plasma lipid and lipoprotein variation. , 1985, American journal of human genetics.

[31]  S. Zeisel,et al.  Erratum: Concentrations of choline-containing compounds and betaine in common foods (Journal of Nutrition (2003) 133 (1302-1307)) , 2003 .

[32]  J. Salonen,et al.  Ultrasound B-mode imaging in observational studies of atherosclerotic progression. , 1993, Circulation.

[33]  G. Heiss,et al.  Association of egg consumption and calcified atherosclerotic plaque in the coronary arteries: the NHLBI Family Heart Study. , 2014, e-SPEN journal.

[34]  R. Sacco,et al.  Egg consumption and carotid atherosclerosis in the Northern Manhattan study. , 2014, Atherosclerosis.

[35]  M. Uusitupa,et al.  Effect of apolipoprotein E polymorphism on serum lipid response to the separate modification of dietary fat and dietary cholesterol. , 1998, The American journal of clinical nutrition.

[36]  Ze-yu Li,et al.  Lutein supplementation reduces plasma lipid peroxidation and C-reactive protein in healthy nonsmokers. , 2013, Atherosclerosis.

[37]  Elizabeth J Johnson,et al.  Dietary cholesterol and cardiovascular disease: a systematic review and meta-analysis. , 2015, The American journal of clinical nutrition.

[38]  Tomi-Pekka Tuomainen,et al.  Egg consumption and risk of incident type 2 diabetes in men: the Kuopio Ischaemic Heart Disease Risk Factor Study. , 2015, The American journal of clinical nutrition.

[39]  Zeneng Wang,et al.  Intestinal Microbial Metabolism of Phosphatidylcholine and Cardiovascular Risk , 2013 .

[40]  Yasuyuki Nakamura,et al.  Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis. , 2013, The American journal of clinical nutrition.

[41]  J. Mursu,et al.  Regular consumption of eggs does not affect carotid plaque area or risk of acute myocardial infarction in Finnish men. , 2013, Atherosclerosis.

[42]  D. Hegsted,et al.  Quantitative effects of dietary fat on serum cholesterol in man. , 1965, The American journal of clinical nutrition.

[43]  T. Wadden,et al.  Reprint: 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk. , 2014, Journal of the American Pharmacists Association : JAPhA.

[44]  C. Ehnholm,et al.  Intestinal cholesterol absorption efficiency in man is related to apoprotein E phenotype. , 1987, The Journal of clinical investigation.

[45]  R. Rauramaa,et al.  HDL, HDL_2, and HDL_3 subfractions, and the risk of acute myocardial infarction , 1991 .

[46]  R. Sacco,et al.  The Northern Manhattan Study , 2004 .

[47]  L. Barraj,et al.  Egg consumption and CHD and stroke mortality: a prospective study of US adults , 2010, Public Health Nutrition.

[48]  M. Fernández,et al.  Whole egg consumption improves lipoprotein profiles and insulin sensitivity to a greater extent than yolk-free egg substitute in individuals with metabolic syndrome. , 2013, Metabolism: clinical and experimental.

[49]  A. Chait,et al.  Cholesterol Feeding Increases C-Reactive Protein and Serum Amyloid A Levels in Lean Insulin-Sensitive Subjects , 2005, Circulation.