Dietary cholesterol and coronary artery disease: A systematic review


Coronary heart disease (CHD) remains one of the leading causes of death in the United States and other industrialized nations. A better understanding of modifiable risk factors for CHD is critical in order to effectively prevent this disease. Dietary factors known to influence the risk of CHD include saturated fats, trans-fats, and polyunsaturated fatty acids. Although higher plasma levels of low-density lipoprotein cholesterol are associated with an increased risk of coronary disease and lipid-lowering therapy has been shown to reduce the risk of cardiovascular disease, the relation between dietary cholesterol and the risk of CHD is not clearly understood. This article reviews the current evidence on the association between dietary cholesterol and the risk of CHD.

This is a preview of subscription content, access via your institution.

References and Recommended Reading

  1. 1.

    Lloyd-Jones D, Adams R, Carnethon M, et al.: Heart disease and stroke statistics-2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009, 119:e21–181.

    Article  PubMed  Google Scholar 

  2. 2.

    Ford ES, Ajani UA, Croft JB, et al.: Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med 2007, 356:2388–2398.

    Article  CAS  PubMed  Google Scholar 

  3. 3.

    Cotton PA, Subar AF, Friday JE, Cook A: Dietary sources of nutrients among US adults, 1994 to 1996. J Am Diet Assoc 2004, 104:921–930.

    Article  PubMed  Google Scholar 

  4. 4.

    Thompson FE, Dennison BA: Dietary sources of fats and cholesterol in US children aged 2 through 5 years. Am J Public Health 1994, 84:799–806.

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    U.S. Department of Health and Human Services: Dietary Guidelines for Americans. Available at Accessed June 2, 2009.

  6. 6.

    National Heart, Lung and Blood Institute: Third Report of the National Cholesterol Education Program. Available at Accessed on June 2, 2009.

  7. 7.

    Kromhout D, Menotti A, Bloemberg B, et al.: Dietary saturated and trans fatty acids and cholesterol and 25-year mortality from coronary heart disease: the Seven Countries Study. Prev Med 1995, 24:308–315.

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    Stamler J, Shekelle R: Dietary cholesterol and human coronary heart disease. The epidemiologic evidence. Arch Pathol Lab Med 1988, 112:1032–1040.

    CAS  PubMed  Google Scholar 

  9. 9.

    McGee DL, Reed DM, Yano K, et al.: Ten-year incidence of coronary heart disease in the Honolulu Heart Program. Relationship to nutrient intake. Am J Epidemiol 1984, 119:667–676.

    CAS  PubMed  Google Scholar 

  10. 10.

    Shekelle RB, Stamler J: Dietary cholesterol and ischaemic heart disease. Lancet 1989, 1:1177–1179.

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    Posner BM, Cobb JL, Belanger AJ, et al.: Dietary lipid predictors of coronary heart disease in men. The Framingham Study. Arch Intern Med 1991, 151:1181–1187.

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    Esrey KL, Joseph L, Grover SA: Relationship between dietary intake and coronary heart diease mortality: Lipid Research Clinics Prevalence Follow-up Study. J Clin Epidemiol 1996, 49:211–216.

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Hu FB, Stampfer MJ, Manson JE, et al.: Dietary fat intake and the risk of coronary heart disease in women. N Engl J Med 1997, 337:1491–1499.

    Article  CAS  PubMed  Google Scholar 

  14. 14.

    Ascherio A, Rimm EB, Giovannucci EL, et al.: Dietary fat and risk of coronary heart disease in men: cohort follow up study in the United States. BMJ 1996, 313:84–90.

    CAS  PubMed  Google Scholar 

  15. 15.

    Kritchevsky SB, Kritchevsky D: Egg consumption and coronary heart disease: an epidemiologic overview. J Am Coll Nutr 2000, 19:549S–555S.

    CAS  PubMed  Google Scholar 

  16. 16.

    Gramenzi A, Gentile A, Fasoli M: Association between certain foods and risk of acute myocardial infarction in women. BMJ 1990, 300:771–773.

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Dawber TR, Nickerson RJ, Brand FN, Pool J: Eggs, serum cholesterol, and coronary heart disease. Am J Clin Nutr 1982, 36:617–625.

    CAS  PubMed  Google Scholar 

  18. 18.

    Fraser GE: Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists. Am J Clin Nutr 1999, 70:532S–538S.

    CAS  PubMed  Google Scholar 

  19. 19.

    Hu FB, Stampfer MJ, Rimm EB, et al.: A prospective study of egg consumption and risk of cardiovascular disease in men and women. JAMA 1999, 281:1387–1394.

    Article  CAS  PubMed  Google Scholar 

  20. 20.

    Mann JI, Appleby PN, Key TJ, Thorogood M: Dietary determinants of ischaemic heart disease in health conscious individuals. Heart 1997, 78:450–455.

    CAS  PubMed  Google Scholar 

  21. 21.

    Djousse L, Gaziano JM: Egg consumption in relation to cardiovascular disease and mortality: The Physicians’ Health Study. Am J Clin Nutr 2008, 87:964–969.

    CAS  PubMed  Google Scholar 

  22. 22.

    Djousse L, Gaziano JM, Buring JE, Lee IM: Egg consumption and risk of type 2 diabetes in men and women. Diabetes Care 2009, 32:295–300.

    Article  PubMed  Google Scholar 

  23. 23.

    Katz DL, Evans MA, Nawaz H, et al.: Egg consumption and endothelial function: a randomized controlled crossover trial. Int J Cardiol 2005, 99:65–70.

    Article  PubMed  Google Scholar 

  24. 24.

    Clarke R, Frost C, Collins R, et al.: Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies. BMJ 1997, 314:112–117.

    CAS  PubMed  Google Scholar 

  25. 25.

    Howell WH, McNamara DJ, Tosca MA, et al.: Plasma lipid and lipoprotein responses to dietary fat and cholesterol: a meta-analysis. Am J Clin Nutr 1997, 65:1747–1764.

    CAS  PubMed  Google Scholar 

  26. 26.

    McNamara DJ: The impact of egg limitations on coronary heart disease risk: do the numbers add up? J Am Coll Nutr 2000, 19:540S–548S.

    CAS  PubMed  Google Scholar 

  27. 27.

    Greene CM, Zern TL, Wood RJ, et al.: Maintenance of the LDL cholesterol:HDL cholesterol ratio in an elderly population given a dietary cholesterol challenge. J Nutr 2005, 135:2793–2798.

    CAS  PubMed  Google Scholar 

  28. 28.

    Goodrow EF, Wilson TA, Houde SC, et al.: Consumption of one egg per day increases serum lutein and zeaxanthin concentrations in older adults without altering serum lipid and lipoprotein cholesterol concentrations. J Nutr 2006, 136:2519–2524.

    CAS  PubMed  Google Scholar 

  29. 29.

    Herron KL, Vega-Lopez S, Conde K, et al.: Pre-menopausal women, classified as hypo- or hyperresponders, do not alter their LDL/HDL ratio following a high dietary cholesterol challenge. J Am Coll Nutr 2002, 21:250–258.

    PubMed  Google Scholar 

  30. 30.

    Jones PJ, Pappu AS, Hatcher L, et al.: Dietary cholesterol feeding suppresses human cholesterol synthesis measured by deuterium incorporation and urinary mevalonic acid levels. Arterioscler Thromb Vasc Biol 1996, 16:1222–1228.

    CAS  PubMed  Google Scholar 

  31. 31.

    Ostlund RE Jr, Bosner MS, Stenson WF: Cholesterol absorption efficiency declines at moderate dietary doses in normal human subjects. J Lipid Res 1999, 40:1453–1458.

    CAS  PubMed  Google Scholar 

  32. 32.

    Knopp RH, Retzlaff B, Fish B, et al.: Effects of insulin resistance and obesity on lipoproteins and sensitivity to egg feeding. Arterioscler Thromb Vasc Biol 2003, 23:1437–1443.

    Article  CAS  PubMed  Google Scholar 

  33. 33.

    Tannock LR, O’Brien KD, Knopp RH, et al.: Cholesterol feeding increases C-reactive protein and serum amyloid A levels in lean insulin-sensitive subjects. Circulation 2005, 111:3058–3062.

    Article  CAS  PubMed  Google Scholar 

  34. 34.

    Shaffer EA, Small DM: Biliary lipid secretion in cholesterol gallstone disease. The effect of cholecystectomy and obesity. J Clin Invest 1977, 59:828–840.

    Article  CAS  PubMed  Google Scholar 

  35. 35.

    Ros E: Intestinal absorption of triglyceride and cholesterol. Dietary and pharmacological inhibition to reduce cardiovascular risk. Atherosclerosis 2000, 151:357–379.

    Article  CAS  PubMed  Google Scholar 

  36. 36.

    Flynn MA, Anderson A, Rutledge M, et al.: Eggs, serum lipids, emotional stress, and blood pressure in medical students. Arch Environ Health 1984, 39:90–95.

    CAS  PubMed  Google Scholar 

  37. 37.

    Sacks FM, Marais GE, Handysides G, et al.: Lack of an effect of dietary saturated fat and cholesterol on blood pressure in normotensives. Hypertension 1984, 6:193–198.

    CAS  PubMed  Google Scholar 

  38. 38.

    Oh SY, Ryue J, Hsieh CH, Bell DE: Eggs enriched in omega-3 fatty acids and alterations in lipid concentrations in plasma and lipoproteins and in blood pressure. Am J Clin Nutr 1991, 54:689–695.

    CAS  PubMed  Google Scholar 

  39. 39.

    Vorster HH, Silvis N, Venter CS, et al.: Serum cholesterol, lipoproteins, and plasma coagulation factors in South Africa blacks on a high-egg but low-fat intake. Am J Clin Nutr 1987, 46:52–57.

    CAS  PubMed  Google Scholar 

  40. 40.

    Armstrong B, van Merwyk AJ, Coates H: Blood pressure in Seventh-day Adventist vegetarians. Am J Epidemiol 1977, 105:444–449.

    CAS  PubMed  Google Scholar 

  41. 41.

    Meyer KA, Kushi LH, Jacobs DR Jr, Folsom AR: Dietary fat and incidence of type 2 diabetes in older Iowa women. Diabetes Care 2001, 24:1528–1535.

    Article  CAS  PubMed  Google Scholar 

  42. 42.

    Salmeron J, Hu FB, Manson JE, et al.: Dietary fat intake and risk of type 2 diabetes in women. Am J Clin Nutr 2001, 73:1019–1026.

    CAS  PubMed  Google Scholar 

  43. 43.

    Gonzalez-Clemente JM, Carro O, Gallach I, et al.: Increased cholesterol intake in women with gestational diabetes mellitus. Diabetes Metab 2007, 33:25–29.

    Article  CAS  PubMed  Google Scholar 

  44. 44.

    Freeman DJ, Norrie J, Sattar N, et al.: Pravastatin and the development of diabetes mellitus: evidence for a protective treatment effect in the West of Scotland Coronary Prevention Study. Circulation 2001, 103:357–362.

    CAS  PubMed  Google Scholar 

  45. 45.

    Ridker PM, Danielson E, Fonseca FA, et al.: Reduction in C-reactive protein and LDL cholesterol and cardiovascular event rates after initiation of rosuvastatin: a prospective study of the JUPITER trial. Lancet 2009, 373:1175–1182.

    Article  CAS  PubMed  Google Scholar 

  46. 46.

    Ness GC, Gertz KR: Increased sensitivity to dietary cholesterol in diabetic and hypothyroid rats associated with low levels of hepatic HMG-CoA reductase expression. Exp Biol Med (Maywood) 2004, 229:407–411.

    CAS  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Luc Djoussé.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Djoussé, L., Michael Gaziano, J. Dietary cholesterol and coronary artery disease: A systematic review. Curr Atheroscler Rep 11, 418 (2009).

Download citation


  • Cholesterol
  • Coronary Heart Disease
  • Dietary Cholesterol
  • Arterioscler Thromb Vasc Biol
  • Lipid Research Clinic