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

Am J Clin Nutr. 2016 Mar;103(3):895-901. doi: 10.3945/ajcn.115.122317. Epub 2016 Feb 10.


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).

Keywords: apolipoproteins; atherosclerosis; cholesterol; coronary heart disease; diet.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Apolipoproteins E / metabolism*
  • Carotid Artery Diseases / etiology
  • Carotid Artery Diseases / metabolism
  • Carotid Artery Diseases / physiopathology
  • Carotid Artery, Common / drug effects*
  • Carotid Intima-Media Thickness*
  • Cholesterol, Dietary / administration & dosage
  • Cholesterol, Dietary / adverse effects
  • Cholesterol, Dietary / pharmacology*
  • Coronary Artery Disease / etiology*
  • Coronary Artery Disease / metabolism
  • Coronary Artery Disease / physiopathology
  • Diet
  • Eggs* / adverse effects
  • Finland
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Phenotype*
  • Prospective Studies
  • Risk Factors


  • Apolipoproteins E
  • Cholesterol, Dietary