The Impact of Dietary Cholesterol on Low-Density Lipoprotein: Lessons in Absorption and Overconsumption

This case describes a 58-year-old woman with past medical history of ulcerative colitis, hyperlipidemia, and radiological evidence of atherosclerosis without prior cardiovascular disease who presented for management of hyperlipidemia. At baseline, her lipid panel in 2015 noted a calculated low-density lipoprotein (LDL-C) of 125 mg/dL (3.2 mmol/L). Over the course of the next 5 years, she developed severe LDL elevations to >400 mg/dL (>10.3 mmol/L) following the addition of 1600 mg dietary cholesterol daily achieved through 9 eggs. Following cessation of this intake she had dramatic improvements in LDL, which was later further augmented significantly by initiation of ezetimibe. The impact of dietary cholesterol on lipid profiles has long been an area of controversy, and, for the average American, current guidelines do not recommend egg restriction as an effective tool for LDL lowering. However, as highlighted in this case, certain individuals may be more prone to high LDL when consuming high cholesterol diets. Further study on how to better identify these susceptible individuals could help improve nutritional and medication treatment plans for patients with dyslipidemia.