--- topic: "Eggs" title: "Eggs, Cholesterol, and Heart Health" order: 2 description: "Big studies disagree on whether eggs raise heart-disease risk. About an egg a day looks fine for most healthy people; diabetes and high LDL need more care." question: "Do eggs raise your cholesterol or heart-disease risk?" answer: "Probably not for most healthy people: up to about one egg a day shows no clear heart-disease risk, though eggs can nudge LDL up." actions: - "Keep to about one whole egg a day, eaten with vegetables and olive oil, not bacon and white toast: in large cohorts, egg eaters also ate more red meat [1]." - "Recheck your cholesterol a few weeks after making eggs a daily habit, because LDL responses vary from person to person [2][3]." cautions: - "With diabetes, heart disease or high LDL, ask your clinician about eggs; cohorts linked eggs to heart disease in diabetes [4]; a 12-month trial found no harm to markers [5]." - "Pregnant, older or immunocompromised people should avoid raw or undercooked eggs, including runny yolks and homemade mayonnaise or desserts with raw egg: shell eggs drove decades of Salmonella outbreaks [6]." confidence: 4 confidenceNote: "Pooled cohorts and meta-analyses mostly find no heart-disease link up to an egg a day; one large US analysis disagrees, trials show small LDL rises, and review quality is low." evidenceSummary: rctCount: 2 observationalCount: 4 metaAnalysisCount: 4 totalParticipants: "900,000+ across cohorts (some overlap)" replicated: false newestStudyYear: 2025 references: - id: "1" pmid: "32132002" title: "Egg consumption and risk of cardiovascular disease: three large prospective US cohort studies, systematic review, and updated meta-analysis" authors: "Drouin-Chartier JP, Chen S, Li Y, et al." year: 2020 journal: "BMJ" - id: "2" pmid: "29596318" title: "Dietary Cholesterol, Serum Lipids, and Heart Disease: Are Eggs Working for or Against You?" authors: "Blesso CN, Fernandez ML" year: 2018 journal: "Nutrients" - id: "3" pmid: "39934049" title: "Effect of egg consumption on health outcomes: An updated umbrella review of systematic reviews and meta-analysis of observational and intervention studies" authors: "Formisano E, Lopes Neri LC, Caffa I, et al." year: 2025 journal: "Nutr Metab Cardiovasc Dis" - id: "4" pmid: "23676423" title: "Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis" authors: "Shin JY, Xun P, Nakamura Y, et al." year: 2013 journal: "Am J Clin Nutr" - id: "5" pmid: "29741558" title: "Effect of a high-egg diet on cardiometabolic risk factors in people with type 2 diabetes: the Diabetes and Egg (DIABEGG) Study-randomized weight-loss and follow-up phase" authors: "Fuller NR, Sainsbury A, Caterson ID, et al." year: 2018 journal: "Am J Clin Nutr" - id: "6" pmid: "16838242" title: "Salmonella enterica serotype Enteritidis and eggs: a national epidemic in the United States" authors: "Braden CR" year: 2006 journal: "Clin Infect Dis" - id: "7" pmid: "31965140" title: "Association of egg intake with blood lipids, cardiovascular disease, and mortality in 177,000 people in 50 countries" authors: "Dehghan M, Mente A, Rangarajan S, et al." year: 2020 journal: "Am J Clin Nutr" - id: "8" pmid: "30874756" title: "Associations of Dietary Cholesterol or Egg Consumption With Incident Cardiovascular Disease and Mortality" authors: "Zhong VW, Van Horn L, Cornelis MC, et al." year: 2019 journal: "JAMA" - id: "9" pmid: "11333841" title: "Dietary cholesterol from eggs increases the ratio of total cholesterol to high-density lipoprotein cholesterol in humans: a meta-analysis" authors: "Weggemans RM, Zock PL, Katan MB" year: 2001 journal: "Am J Clin Nutr" - id: "10" pmid: "33561122" title: "Egg and cholesterol consumption and mortality from cardiovascular and different causes in the United States: A population-based cohort study" authors: "Zhuang P, Wu F, Mao L, et al." year: 2021 journal: "PLoS Med" - id: "11" pmid: "31838890" title: "Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association" authors: "Carson JAS, Lichtenstein AH, Anderson CAM, et al." year: 2020 journal: "Circulation" - id: "12" pmid: "32464420" title: "Whole egg consumption increases plasma choline and betaine without affecting TMAO levels or gut microbiome in overweight postmenopausal women" authors: "Zhu C, Sawrey-Kubicek L, Bardagjy AS, et al." year: 2020 journal: "Nutr Res" --- For most healthy people, up to about an egg a day is probably fine. Large pooled analyses mostly find no link between eggs and heart disease [1][7], though one US analysis tied each extra half egg a day to about 6% more cardiovascular disease [8]. Eggs do nudge LDL cholesterol up in some people [9], and the evidence is less settled for people with diabetes [4]. ## How it works **Why eggs were blamed.** Eggs are a major source of dietary cholesterol, and in controlled feeding studies each extra 100 mg of it a day raised total cholesterol by about 2.2 mg/dL and nudged the ratio of total to HDL cholesterol up [9]. A 2025 umbrella review found LDL about 7 mg/dL higher on average with egg intake, but rated the evidence very weak [3]. Responses differ: roughly two-thirds of people change little, and those who do respond tend to raise both LDL and HDL [2]. **What long-term studies find.** Three US cohorts of 215,618 people found that eating at least one egg a day was not linked to cardiovascular disease, and a meta-analysis found no association per egg per day, with possibly lower risk in Asian cohorts [1]. In three international studies (PURE, ONTARGET and TRANSCEND) covering about 177,000 people in 50 countries, egg intake was unrelated to lipids, death or major cardiovascular events [7]. The dissent: pooled US data tied each extra half egg a day to 6% more cardiovascular disease and 8% higher mortality, but the egg link vanished after adjusting for dietary cholesterol [8], and a cohort of 521,120 older Americans found 7% higher all-cause mortality per half egg [10]. **Why studies disagree.** People who eat more eggs tend to eat more red meat, have a higher BMI and use fewer statins [1], so what eggs are eaten with may matter as much as the eggs. The American Heart Association says dietary guidance should focus on healthy patterns such as Mediterranean-style and DASH-style diets, which are inherently relatively low in cholesterol [11]. **Diabetes.** A meta-analysis linked higher egg intake to more type 2 diabetes and to more cardiovascular disease among people who already had diabetes [4]. Yet in a randomized trial of 128 people with prediabetes or type 2 diabetes, 12 or more eggs a week caused no adverse changes in cholesterol, blood sugar control or inflammation compared with fewer than two [5]. **TMAO and choline.** Gut bacteria can turn choline in eggs into TMAO, a compound associated with cardiovascular risk. In a crossover trial, two eggs a day for four weeks raised blood choline and betaine but not TMAO [12]. See [TMAO](/tmao/gut-bacteria-cardiovascular-link) and [choline](/choline/brain-and-liver). **In practice.** About one egg a day fits most healthy diets. For nutrition, see [eggs: the perfect food](/eggs/the-perfect-food); for pasture-raised and organic eggs, see [organic meat, dairy and eggs](/organic-food/organic-meat-dairy-and-eggs). ## The evidence in detail ### Large analyses that disagree The Zhong analysis pooled individual data from six US cohorts (29,615 adults, median follow-up 17.5 years, 5,400 cardiovascular events, 6,132 deaths). Each extra 300 mg of dietary cholesterol a day went with higher cardiovascular risk (HR 1.17, 1.09 to 1.26) and mortality (HR 1.18, 1.10 to 1.26); each extra half egg a day went with HR 1.06 (1.03 to 1.10) for cardiovascular disease, an absolute increase of 1.11%, and 1.08 for mortality. After adjusting for dietary cholesterol, egg associations were no longer significant (HR 0.99 for cardiovascular disease, 1.03 for mortality) [8]. The Harvard analysis followed 215,618 US nurses and health professionals for up to 32 years (14,806 events): at least one egg a day versus less than one a month gave HR 0.93 (0.82 to 1.05). Its meta-analysis of 33 estimates (1.72 million people, 139,195 events) found RR 0.98 (0.93 to 1.03) per daily egg, with US 1.01, European 1.05 and Asian 0.92 (0.85 to 0.99) [1]. The NIH-AARP cohort (521,120 people, 129,328 deaths over a median 16 years) found HR 1.07 per half egg for all-cause, cardiovascular and cancer mortality, with cholesterol mediating about 62% of the cardiovascular figure [10]. In PURE (146,011 people in 21 countries), seven or more eggs a week versus less than one gave HR 0.96 (0.89 to 1.04) for the composite outcome, 1.04 for mortality and 0.92 (0.83 to 1.01) for major cardiovascular disease, with similar results in 31,544 people with vascular disease [7]. ### Cholesterol and lipid evidence A meta-analysis of 17 controlled feeding studies (556 people) found each 100 mg of added dietary cholesterol raised total cholesterol 0.056 mmol/L (2.2 mg/dL), HDL 0.3 mg/dL and the total-to-HDL ratio by 0.020 (0.010 to 0.030), and concluded that advice to limit cholesterol may still be valid [9]. The 2025 umbrella review covered 14 meta-analyses since 2020 and found LDL higher by 7.39 mg/dL (5.82 to 8.95) and total cholesterol by 9.12 mg/dL (7.35 to 10.89) with egg intake, but no association with cardiovascular outcomes or all-cause mortality. It rated evidence quality critically low and concluded there was insufficient evidence to discourage eggs [3]. A review by researchers who report prior funding from the Egg Nutrition Center describes variable responses, with about two-thirds of people minimally affected, and an LDL-to-HDL ratio that is typically maintained in responders [2]. The AHA advisory judged observational data generally unrelated to cardiovascular risk, while most trial meta-analyses link intakes above the current average to higher total or LDL cholesterol [11]. ### Diabetes and TMAO A meta-analysis of 22 cohorts found no link between at least one egg a day and cardiovascular disease overall (HR 0.96, 0.88 to 1.05), but higher type 2 diabetes incidence (HR 1.42, 1.09 to 1.86) and, in people with diabetes, higher cardiovascular disease (HR 1.69, 1.09 to 2.62) [4]. The DIABEGG trial randomized 128 people with prediabetes or type 2 diabetes to a high-egg (12 or more a week) or low-egg (under two) diet through 3 months of weight loss and 6 months of follow-up. Weight loss was the same (about 3.1 kg), and there were no differences in glycemia, lipids, inflammation, oxidative stress or adiponectin [5]. In a crossover trial of 20 overweight postmenopausal women with mildly raised cholesterol, two whole eggs a day versus a yolk-free substitute for four weeks raised plasma choline and betaine, yet TMAO and gut microbiome composition did not change [12]. ### Where the evidence conflicts Egg intake in cohorts relies on food-frequency questionnaires, and egg eaters differ in diet and habits. US analyses disagree with one another, and Asian cohorts point the other way. Trials measure risk markers, not heart attacks. Safety is separate from heart health: shell eggs were the main vehicle of a Salmonella Enteritidis epidemic from the 1970s, which fell after farm, refrigeration and consumer-education measures, though outbreaks persist [6]. ### Bottom line Confidence is 4 of 5 for the general population: about an egg a day is not clearly harmful, and may nudge LDL up in some. Confidence is lower for people with diabetes or high LDL, where individual advice is warranted.