In the majority of the population, dietary cholesterol affects serum cholesterol levels only a little, and few studies have linked the intake of dietary cholesterol to an elevated risk of cardiovascular diseases. Globally, many nutrition recommendations no longer set limitations to the intake of dietary cholesterol.
Some studies have found an association between high dietary cholesterol intake and an increased risk of stroke, while others have associated the consumption of eggs, which are high in cholesterol, with a reduced risk of stroke.
For most people, dietary cholesterol plays a very small role in affecting their serum cholesterol levels. However, in carriers of the apolipoprotein E phenotype 4 – which significantly impacts cholesterol metabolism –, the effect of dietary cholesterol on serum cholesterol levels is greater.
In Finland, the prevalence of APOE4, which is a hereditary variant, is exceptionally high, with approximately one-third of the population presenting as carriers. Yet, research data on the association between a high intake of dietary cholesterol and the risk of stroke in this population group has not been available until now.
Now, in a new study by the University of Eastern Finland, scientists show that a moderately high intake of dietary cholesterol or consumption of up to one egg per day is not associated with an elevated risk of stroke. They did not find any association in carriers of the APOE4 phenotype, which affects cholesterol metabolism and is remarkably common among the Finnish population.
A total of 1950 men aged 42–60 y in 1984–1989 were included at the baseline examinations of the prospective population-based Kuopio Ischaemic Heart Disease Risk Factor Study, KIHD, in 1984–1989 at the University of Eastern Finland. APOE phenotype data were available for 1,015 of the men participating in the study. Of those, 32% were known carriers of APOE4.
During a follow-up of 21 years, 217 men were diagnosed with a stroke. The study found that neither dietary cholesterol nor egg consumption was associated with the risk of stroke – not even in carriers of APOE4.
The findings suggest that moderate cholesterol intake or daily egg consumption are not associated with the risk of stroke, even in persons who are genetically predisposed to a greater effect of dietary cholesterol on serum cholesterol levels. In the highest control group, the study participants had an average daily dietary cholesterol intake of 520 mg, and they consumed an average of one egg per day, which means that the findings cannot be generalized beyond these levels. One egg contains approximately 200 mg of cholesterol.
The study found that about a fourth of the total dietary cholesterol consumed came from eggs. Furthermore, the generalisability of this study is also weakened by the fact that the study population did not have a pre-existing cardiovascular disease at baseline, and the size of the study population was relatively small. Therefore, the findings of the study should be verified in a larger cohort as well as in people with a pre-existing cardiovascular disease, who are currently advised to limit their intake of cholesterol and eggs.
Scientists have published their results in the American Journal of Clinical Nutrition.