To estimate dietary cholesterol contribution to CHD risk among US females, relative to other dietary risk factors.

A risk apportionment model was applied to apportion CHD risk shares among the lifestyle and dietary risk factors.

The model was implemented using relative risks from the Nurses’ Health Study and data on CHD risk factors and consumption from the National Health and Nutrition Examination Survey 1999–2002.

US females aged 25 years or older.

On average, poor diet contributes 20 % of the CHD risk relative to obesity, inactivity and smoking, of which trans fat intake contributes 2·9 %, dietary cholesterol 1·5 % and 16 % is due to low consumption of nutrients, i.e. MUFA (1·5 %), PUFA (1·7 %), marine n-3 fatty acids (2·7 %), α-linolenic acid (1·1 %), dietary fibre (2·4 %), vitamin B6 (4·1 %), vitamin C (0·5 %) and folate (1·8 %).

Reducing trans fat and dietary cholesterol intakes could lead to CHD reduction, but greater risk reduction may be achieved by improving intakes of heart-healthy nutrients currently deficient in US females’ diets. Total diet consideration is essential in any CHD risk reduction strategy.