ODP152 Impact of Dietary Cholesterol on LDL: Lessons in Absorption and Overconsumption

BACKGROUND: The impact of dietary cholesterol on lipid profiles have remained controversial, highlighted by alterations in the 2015-2020 American Heart Association dietary guidelines abolishing the prior dietary cholesterol limit of 300mg/day. Eggs often are the example cited in this debate as they are a rich source of dietary cholesterol without comparative high levels of saturated fat, 1 of which the effects on LDL cholesterol are well established. To date, evidence has been mixed although most studies show only modest increases in LDL with dietary cholesterol. 1 However, recent research supports significant variation in these findings among predisposed individuals. 2 Heterogeneity in dietary cholesterol absorption can potentially account for these variations and has important clinical implications. CLINICAL CASE: A 58 year old woman with PMH ulcerative colitis, hyperlipidemia, and radiological evidence of CAD without prior CVD, presented for management of hyperlipidemia. At baseline, her lipid panel in 2015 noted an LDL-C of 125 mg/dL. In 2017, LDL-C was 255 mg/dL, prompting treatment with Atorvastatin. Following initiation of Atorvastatin, LDL-C improved to 137 mg/dL. However, on Atorvastatin, she experienced dermatitis and underwent Dermatology evaluation/biopsy. Medication reaction was favored as the etiology and Atorvastatin was discontinued. In Jan. 2019, off of Atorvastatin, LDL-C was 162 mg/dL. From around 2015-2018, the patient consumed a vegan diet. In 2019, she incorporated nine eggs per day (1600mg dietary cholesterol) into her diet. She denied additional changes to diet or consumption of other animal products. In Aug. 2019, LDL-C was 378 mg/dL. In Aug. 2020, LDL-C was 420 mg/dL. In Aug. 2020, she was advised that her goal LDL was 100 mg/dL or less. She was advised to limit her egg yolk consumption to four per week (∼100 mg/day of cholesterol). She continued to avoid all other animal products. In Oct. 2020, without addition of medication or other notable lifestyle changes her LDL-C decreased to 204 mg/dL. In Jan. 2021, her LDL-C was 130 mg/dL. From 2015-2021, her weight ranged 93-103lbs (BMI ∼16). In Aug. 2021, her LDL-C was 142 mg/dL. Ezetimibe 10mg daily was then added with reduction in LDL-C to a near-target of 103 mg/dL (27% reduction) within four months. CONCLUSION: For the average American, current guidelines do not recommend egg restriction as an effective tool for LDL-C lowering. However, as shown in this case, certain individuals may be more prone to high LDL-C when consuming high cholesterol diets. Further study on how to better identify these susceptible individuals could help personalize nutritional and medication treatment plans for patients with dyslipidemia. References: Blesso CN, Fernandez ML. Dietary Cholesterol, Serum Lipids, and Heart Disease: Are Eggs Working for or Against You? Nutrients. 2018 Mar 29;10(4): 426. Grundy SM. Does Dietary Cholesterol Matter? Curr Atheroscler Rep. 2016 Nov;18(11): 68. Presentation: No date and time listed