Egg consumption and risk of coronary artery disease, potential amplification by high genetic susceptibility: a prospective cohort study

Xue Xia; Fangchao Liu; Keyong Huang; Shufeng Chen; Jianxin Li; Jie Cao; Xueli Yang; Xiaoqing Liu; Chong Shen; Ling Yu; Yingxin Zhao; Liancheng Zhao; Ying Li; Dongsheng Hu; Jiangfeng Huang; Xiangfeng Lu; Dongfeng Gu

doi:10.1016/j.ajcnut.2023.06.009

Egg consumption and risk of coronary artery disease, potential amplification by high genetic susceptibility: a prospective cohort study

Am J Clin Nutr. 2023 Oct;118(4):773-781. doi: 10.1016/j.ajcnut.2023.06.009. Epub 2023 Aug 21.

Authors

Xue Xia¹, Fangchao Liu², Keyong Huang³, Shufeng Chen³, Jianxin Li³, Jie Cao³, Xueli Yang⁴, Xiaoqing Liu⁵, Chong Shen⁶, Ling Yu⁷, Yingxin Zhao⁸, Liancheng Zhao³, Ying Li³, Dongsheng Hu⁹, Jiangfeng Huang³, Xiangfeng Lu¹⁰, Dongfeng Gu¹¹

Affiliations

¹ Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing, China.
³ Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁴ Tianjin Key Laboratory of Environment, Nutrition and Public Health, Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China.
⁵ Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China.
⁶ Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China.
⁷ Department of Cardiology, Fujian Provincial Hospital, Fuzhou, China.
⁸ Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China.
⁹ Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China; Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, China.
¹⁰ Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing, China. Electronic address: luxf@pumc.edu.cn.
¹¹ Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing, China; School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China. Electronic address: gudongfeng@cashq.ac.cn.

PMID: 37793743
DOI: 10.1016/j.ajcnut.2023.06.009

Abstract

Background: Remarkable heterogeneity has been observed among population-based studies on egg consumption and risk of coronary artery disease (CAD). Whether genetic susceptibility serves as a potential explanation for this inconsistency remains unknown.

Objectives: We performed a prospective cohort study to investigate the association of egg consumption with incident CAD at different genetic susceptibilities.

Methods: We included 34,111 participants without CAD at baseline from the project of Prediction for Atherosclerotic Cardiovascular Disease Risk in China. Egg consumption was assessed with food frequency questionnaires. Genetic susceptibility was quantified by a predefined polygenic risk score (PRS) with 540 genetic variants. The hazard ratio (HR) and 95% confidence interval (95% CI) of incident CAD associated with egg consumption and PRS were estimated using the Cox proportional hazards models.

Results: Over a median 11.7 y of follow-up, 1,128 incident cases of CAD were recorded. Both higher egg consumption and increased PRS were related to higher risk of CAD. When stratified by genetic risk, each increment of 3 eggs/wk was associated with a 5% higher risk of CAD for participants at low to intermediate genetic risk (HR: 1.05; 95% CI: 1.01, 1.09), whereas risk increased to HR 1.10 (95% CI: 1.05, 1.16) for those at high genetic risk; a significant synergistic interaction was also indicated at both multiplicative (P_interaction = 0.007) and additive (relative excess risk: 0.73; 95% CI: 0.24, 1.22) scales. When the joint effect was examined, in comparison with those at low to intermediate genetic risk and consuming <1 egg/wk, the HR (95% CI) was 2.95 (2.41, 3.62) for participants with high genetic risk and consumption of ≥10 eggs/wk, and the corresponding standardized 10-y CAD rates increased from 1.37% to 4.24%.

Conclusions: Genetic predisposition may synergistically interact with egg consumption in relation to increased CAD risk. PRS-stratified recommendations on egg consumption may help formulate personalized nutrition policies.

Keywords: cohort study; coronary artery disease; egg consumption; interaction effect; polygenic risk score.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

China
Coronary Artery Disease* / epidemiology
Coronary Artery Disease* / genetics
Genetic Predisposition to Disease
Humans
Prospective Studies
Risk Factors