• While eggs provide a rich source of nutrients, their considerable cholesterol content has lead to the hypothesis that increased egg consumption could put individuals at risk for poor cardiovascular outcomes. This hypothesis has been controversial, with different guidelines taking diverging approaches to egg intake, and prior meta-analyses providing inconclusive results.

• The present systematic review and meta-analysis of 23 prospective studies including over 1.4 million individuals explores the overall association between egg consumption and cardiovascular disease. It finds that higher egg consumption (defined here as one or more egg per day) was not associated with increased risk of CVD or stroke, and that higher consumption was actually associated with a reduced risk in coronary artery disease.

INTRODUCTION
Considerable controversy remains on the relationship between egg consumption and cardiovascular disease risk. The objective of this systematic review and meta-analysis was to explore the association between egg consumption and overall cardiovascular disease events.

METHODS
We systematically searched Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception in 1966 through January 2020 for observational studies that reported the association between egg consumption and cardiovascular disease events. Two investigators independently reviewed data. Conflicts were resolved through consensus. Random-effects meta-analyses were used. Sources of heterogeneity were analyzed.

RESULTS
We identified 23 prospective studies with a median follow-up of 12.28 years. A total of 1,415,839 individuals with a total of 123,660 cases and 157,324 cardiovascular disease events were included. Compared with the consumption of no or 1 egg/day, higher egg consumption (more than 1 egg/day) was not associated with significantly increased risk of overall cardiovascular disease events (pooled hazard ratios, 0.99; 95% confidence interval, 0.93-1.06; P < .001; I² = 72.1%). Higher egg consumption (more than 1 egg/day) was associated with a significantly decreased risk of coronary artery disease (pooled hazard ratios, 0.89; 95% confidence interval, 0.86-0.93; P < .001; I² = 0%), compared with consumption of no or 1 egg/day.

CONCLUSIONS
Our analysis suggests that higher consumption of eggs (more than 1 egg/day) was not associated with increased risk of cardiovascular disease, but was associated with a significant reduction in risk of coronary artery disease.

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Journal Abstract