Carbohydrate Restriction-Induced Elevations in LDL Cholesterol and Atherosclerosis: The KETO Trial (JACC: Advances August 2024)-Article: Carbohydrate Restriction-Induced Elevations in LDL Cholesterol and Atherosclerosis: The KETO Trial

Article: Carbohydrate Restriction-Induced Elevations in LDL Cholesterol and Atherosclerosis: The KETO Trial

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The study, titled "Carbohydrate Restriction-Induced Elevations in LDL-Cholesterol and Atherosclerosis: The KETO Trial," explores the impact of ketogenic diets (KETO) on low-density lipoprotein cholesterol (LDL-C) and atherosclerosis in lean mass hyper-responders (LMHR). Conducted by Budoff et al. and published in "JACC Advances," the study aims to assess the coronary plaque burden in LMHR individuals with elevated LDL-C due to carbohydrate restriction, comparing them to matched controls with lower LDL-C levels from the Miami Heart (MiHeart) cohort.<br /><br />Key findings include:<br />1. Study Sample: The study included 80 KETO individuals with significant carbohydrate restriction-induced LDL-C elevation (minimum of 190 mg/dL; mean 272 mg/dL) and 80 matched controls from the MiHeart cohort with lower LDL-C (mean 123 mg/dL). Matching criteria included age, gender, race, hyperlipidemia, hypertension, and smoking status.<br />2. Methods: Researchers used coronary artery calcium (CAC) scores and coronary computed tomography angiography (CCTA) to evaluate and compare coronary plaque burden.<br />3. Results: There was no significant difference in coronary plaque burden between KETO and MiHeart subjects. Median CAC scores, total plaque scores (TPS), and segment involvement scores (SIS) were similar between the two groups.<br />4. Implications: These findings suggest that despite high LDL-C levels, LMHR individuals on ketogenic diets do not exhibit increased coronary plaque burden compared to matched controls with lower LDL-C.<br /><br />The study challenges the conventional understanding that elevated LDL-C is a definitive risk factor for atherosclerosis in all populations, suggesting that the metabolic profile of individuals on carbohydrate-restricted diets may influence the impact of elevated LDL-C. Further research is recommended to delve deeper into the LMHR phenotype and the risk associated with high LDL-C in this group.<br /><br />The research raises questions about the applicability of existing LDL-C guidelines to metabolically healthy individuals on ketogenic diets and suggests the need for tailored clinical approaches for this unique population. The study highlights the importance of considering individual metabolic contexts in the assessment and management of cardiovascular risk.

Keywords

ketogenic diets

LDL cholesterol

atherosclerosis

lean mass hyper-responders

coronary plaque burden

carbohydrate restriction

coronary artery calcium

coronary computed tomography angiography

metabolic profile

cardiovascular risk