Dietary cholesterol intake and egg consumption in relation to all-cause and cardiovascular mortality after stroke

Abstract

The findings on the associations of dietary cholesterol intake and egg consumption with mortality in the general population remain inconclusive. Our objective was to evaluate all-cause and cardiovascular mortality in relation to dietary cholesterol intake and egg consumption in a cohort of stroke survivors, a particularly vulnerable population. We conducted a prospective cohort analysis of 1367 stroke survivors recruited across the United States between 1999 and 2018. Dietary information was evaluated by a 24-h dietary recall at baseline obtained from NHANES while mortality data were derived from the National Death Index with follow-up through 2019. To investigate the associations of dietary cholesterol intake or egg consumption with all-cause and cardiovascular mortality, Cox proportional hazards and restricted cubic splines models were utilized. After a median follow-up of 79.0 months, the incidence per 1000 person-years was 59.9 (95% confidence interval [CI], 55.2-64.9) for all-cause and 23.3 (95% CI, 20.4-26.5) for cardiovascular mortality. Each 100 mg/1000 kcal/day elevation in cholesterol intake was related to raised risk of all-cause (hazard ratio [HR], 1.16; 95% CI, 1.05-1.27) and cardiovascular mortality (HR, 1.15; 95% CI, 1.00-1.31). A greater risk of all-cause mortality was shown in participants consuming > 1 egg/day (HR, 1.40; 95% CI, 1.06-1.84). The dose-response analysis highlighted the lowest risk of all-cause mortality when egg consumption was around 33.3 g/day. The observed correlations of dietary cholesterol intake or egg consumption with all-cause and cardiovascular mortality were stronger in the subgroups with cardiometabolic diseases (obesity, hypertension, diabetes mellitus, hyperlipidemia) or risk factors for cardiometabolic diseases (advanced age). Among stoke survivors, greater dietary cholesterol connects to an escalated risk of all-cause and cardiovascular mortality in a linear manner. Moderate egg consumption (≤ 1 egg/day) is relatively safe and excessive consumption links to an elevated risk of all-cause mortality.

Keywords: Cardiovascular disease; Cholesterol; Diet; Egg; Mortality; Stroke.