Dietary Cholesterol and Cardiovascular Health

Dietary cholesterol is a sterol found primarily in animal-derived foods such as eggs, meat and shellfish. Once ingested, cholesterol influences serum lipid concentrations, notably low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, which in turn modulate the development of atherosclerotic plaques within arterial walls. The relationship between dietary cholesterol and cardiovascular disease (CVD) risk has been reassessed in recent years; guidelines now place greater emphasis on overall dietary pattern and saturated fat intake rather than on cholesterol alone. Interindividual variability in response to dietary cholesterol is observed, influenced by genetics, ethnicity and gut microbial metabolism, including the generation of metabolites such as trimethylamine N-oxide. Eggs remain a focal point, balancing their nutrient density—protein, choline, vitamins and bioactive phospholipids—against concerns over hypercholesterolaemia. Large population studies and controlled trials have yielded mixed results, prompting dietary recommendations that favour moderation within a balanced diet and stress the importance of reducing saturated fats, refining dietary quality and considering specific population needs.

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Dietary Cholesterol and Cardiovascular Health publication trend

The graph below shows the total number of articles in dietary cholesterol and cardiovascular health across all publications each year (not limited to Nature Index journals).

Technical terms

Dietary cholesterol: A lipid sterol present in animal foods that can affect blood cholesterol levels.

Low-density lipoprotein (LDL): A carrier of cholesterol in the bloodstream often termed “bad” cholesterol due to its role in atheroma formation.

High-density lipoprotein (HDL): A carrier of cholesterol known as “good” cholesterol, involved in reverse cholesterol transport from tissues to the liver.

Atherosclerosis: Progressive thickening and hardening of arterial walls due to lipid accumulation and inflammation, leading to CVD events.

Randomized controlled trial (RCT): An experimental study design in which participants are randomly allocated to interventions to assess causal effects on outcomes.

References

1. Eggs and Cardiovascular Disease Risk: An Update of Recent Evidence. Current Atherosclerosis Reports (2023).
2. Egg consumption and risk of cardiovascular disease: three large prospective US cohort studies, systematic review, and updated meta-analysis. The BMJ (2020).
3. Associations of egg consumption with cardiovascular disease in a cohort study of 0.5 million Chinese adults. Heart (2018).
4. The Golden Egg: Nutritional Value, Bioactivities, and Emerging Benefits for Human Health. Nutrients (2019).
5. Dietary Cholesterol and the Lack of Evidence in Cardiovascular Disease. Nutrients (2018).