OBJECTIVE To evaluate the association between egg intake and cardiovascular disease risk among women and men in the United States, and to conduct a meta-analysis of prospective cohort studies. DESIGN Prospective cohort study, and a systematic review and meta-analysis of prospective cohort studies. SETTING Nurses' Health Study (NHS, 1980-2012), NHS II (1991-2013), Health Professionals' Follow-Up Study (HPFS, 1986-2012). PARTICIPANTS Cohort analyses included 83 349 women from NHS, 90 214 women from NHS II, and 42 055 men from HPFS who were free of cardiovascular disease, type 2 diabetes, and cancer at baseline. MAIN OUTCOME MEASURES Incident cardiovascular disease, which included non-fatal myocardial infarction, fatal coronary heart disease, and stroke. RESULTS Over up to 32 years of follow-up (>5.54 million person years), 14 806 participants with incident cardiovascular disease were identified in the three cohorts. Participants with a higher egg intake had a higher body mass index, were less likely to be treated with statins, and consumed more red meats. Most people consumed between one and less than five eggs per week. In the pooled multivariable analysis, consumption of at least one egg per day was not associated with incident cardiovascular disease risk after adjustment for updated lifestyle and dietary factors associated with egg intake (hazard ratio for at least one egg per day v less than one egg per month 0.93, 95% confidence interval 0.82 to 1.05). In the updated meta-analysis of prospective cohort studies (33 risk estimates, 1 720 108 participants, 139 195 cardiovascular disease events), an increase of one egg per day was not associated with cardiovascular disease risk (pooled relative risk 0.98, 95% confidence interval 0.93 to 1.03, I2=62.3%). Results were similar for coronary heart disease (21 risk estimates, 1 411 261 participants, 59 713 coronary heart disease events; 0.96, 0.91 to 1.03, I2=38.2%), and stroke (22 risk estimates, 1 059 315 participants, 53 617 stroke events; 0.99, 0.91 to 1.07, I2=71.5%). In analyses stratified by geographical location (P for interaction=0.07), no association was found between egg consumption and cardiovascular disease risk among US cohorts (1.01, 0.96 to 1.06, I2=30.8%) or European cohorts (1.05, 0.92 to 1.19, I2=64.7%), but an inverse association was seen in Asian cohorts (0.92, 0.85 to 0.99, I2=44.8%). CONCLUSIONS Results from the three cohorts and from the updated meta-analysis show that moderate egg consumption (up to one egg per day) is not associated with cardiovascular disease risk overall, and is associated with potentially lower cardiovascular disease risk in Asian populations. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019129650.

中文翻译：

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鸡蛋消费和心血管疾病风险：三项大型前瞻性美国队列研究、系统评价和更新的荟萃分析。

目的 评估美国女性和男性的鸡蛋摄入量与心血管疾病风险之间的关系，并对前瞻性队列研究进行荟萃分析。设计前瞻性队列研究，以及前瞻性队列研究的系统回顾和荟萃分析。设置护士健康研究 (NHS, 1980-2012), NHS II (1991-2013), 卫生专业人员的后续研究 (HPFS, 1986-2012)。参与者 队列分析包括来自 NHS 的 83 349 名女性、来自 NHS II 的 90 214 名女性和来自 HPFS 的 42 055 名男性，他们在基线时没有心血管疾病、2 型糖尿病和癌症。主要结局指标 心血管疾病，包括非致死性心肌梗死、致死性冠心病和中风。结果 长达 32 年的随访（>554 万人年），在三个队列中确定了 14 806 名患有心血管疾病的参与者。鸡蛋摄入量较高的参与者体重指数较高，接受他汀类药物治疗的可能性较小，并且食用了更多的红肉。大多数人每周食用一到少于五个鸡蛋。在汇总多变量分析中，在调整了与鸡蛋摄入量相关的更新生活方式和饮食因素后，每天至少摄入一个鸡蛋与心血管疾病风险无关（每天至少一个鸡蛋的风险比与每次少于一个鸡蛋的风险比）月 0.93，95% 置信区间 0.82 至 1.05）。在前瞻性队列研究的最新荟萃分析中（33 项风险估计，1 720 108 名参与者，139 195 起心血管疾病事件），每天增加一个鸡蛋与心血管疾病风险无关（合并相对风险 0.98，95% 置信区间 0.93 至 1.03，I2=62.3%）。冠心病（21 项风险估计，1 411 261 名参与者，59 713 起冠心病事件；0.96，0.91 至 1.03，I2=38.2%）和中风（22 项风险估计，1 059 315 名参与者，53 617 名参与者）的结果相似中风事件；0.99，0.91 至 1.07，I2=71.5%）。在按地理位置分层的分析中（交互作用 P = 0.07），在美国队列（1.01, 0.96 至 1.06, I2=30.8%）或欧洲队列（1.05, 0.92 至 1.19, I2=64.7%），但在亚洲队列中观察到负相关（0.92，0.85 至 0.99，I2=44.8%）。结论 来自三个队列和更新的荟萃分析的结果表明，适度食用鸡蛋（每天最多一个鸡蛋）与总体心血管疾病风险无关，并且与亚洲人群潜在的心血管疾病风险降低有关。系统审查注册 PROSPERO CRD42019129650。