Abstract:

Background: Increases in LDL cholesterol (LDL-C) can occur on carbohydrate restricted ketogenic diets. Lean metabolically healthy individuals with low high triglyceride-to-HDL-C ratio "Lean Mass Hyper-Responder"(LMHR) phenotype.

Objectives:To assess coronary plaque burden in LMHR individuals with LDL-C to ≥190 mg/dl(KETO) compared to matched controls with lower LDL-C from the Miami Heart(MiHeart) cohort.

Methods: There were 80 KETO individuals with carbohydrate restriction-induced LDL-C ≥190 mg/dl, HDL-C ≥ 60 mg/dl and triglyceride levels ≤ 80 mg/dl, without familial hypercholesterolemia, matched 1:1 with MiHeart subjects for age, gender, race, hyperlipidemia, hypertension and smoking status. Coronary artery calcium (CAC) and Coronary CT Angiography (CCTA) were used to compare coronary plaque between groups, and correlate LDL-C to plaque levels.

Results: The matched mean age was 55.5 years, with mean LDL-C of 272 (max LDL-C 591) mg/dl and mean 4.7 years duration on a ketogenic diet. There was no significant difference in coronary plaque burden as compared to MiHeart controls (mean LDL 123 mg/dl): CAC score (median and IQR) [0 (0,56)] versus [1 (0, 49)], p = 0.520; CCTA Total Plaque Score [0 (0,2) versus (0,4), p=0.357]. There was also no correlation between LDL-C level and CCTA coronary plaque.

Conclusions: Coronary plaque in metabolically healthy individuals with carbohydrate-restriction induced LDL-C ≥190 mg/dl for mean 4.7 years is not greater than a matched cohort with lower LDL-C. There is no association between LDL-C and plaque burden in either cohort.

JACC: Advances Editor-in-Chief 

Candice K. Silversides, MD, FACC

JACC: Advances CME Editor

Kenneth A. Ellenbogen, MD

Author
Ahmad Slim, MD, FACC, FASNC, FSCCT

Important Dates

Date of Release: August 28, 2024 

Term of Approval/Date of CME/MOC Expiration: August 27, 2025