Dietary cholesterol and cardiovascular morbidity/mortality

Even if hypercholesterolemia is a risk factor for cardiovascular (CV) disease (CVD), the role of dietary cholesterol remains controversial. Basically, the works of Anitshkow in rabbits have shown that a high cholesterol diet resulted in the development of atherosclerotic plaques. In man, intervention studies examined the effect of dietary cholesterol and/or eggs on plasma lipids, leading to conflicting results. They also brought out the complex concept of hypo- and hyper-responder to intestinal cholesterol. Nevertheless, observational epidemiology does not allow concluding about the deleterious effect of dietary cholesterol in humans. However, in diabetic patients, a positive association between consumption and the incidence of CV events is found fairly consistently, without clear explanation. It seems difficult to organize a specific clinical trial examining the impact of foods high in cholesterol on the occurrence of cardiovascular events. But, the results of the two major dietetic intervention studies (MRFIT and PREDIMED) argue against the deleterious effect of dietary cholesterol on CVD. Conversely, the studies on the pharmacological inhibition of intestinal transporter NPC1L1 cholesterol showed not only a decrease of LDL cholesterol level but also a decrease of CVD. But available data are not in favor of a key role of dietary cholesterol in the occurrence of CVD. They do not allow making it a priority target of the diet to prevent cardiovascular disease. (C) 2015 Societe francaise de nutrition. Published by Elsevier Masson SAS. All rights reserved.