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Observational Study
. 2024 Nov 1;35(7):577-583.
doi: 10.1097/MCA.0000000000001395. Epub 2024 Jun 13.

The impact of carbohydrate restriction-induced elevations in low-density lipoprotein cholesterol on progression of coronary atherosclerosis: the ketogenic diet trial study design

Denise Alison R Javier  1 , Venkat S Manubolu  1 , Nicholas G Norwitz  2 , April Kinninger  1 , Jairo Aldana-Bitar  1 , Ahmed Ghanem  1 , Khadije Ahmad  1 , Will D Vicuna  1 , Hossein Hamidi  1 , Marziyeh Bagheri  1 , Tasneem Elsayed  1 , Bea Villanueva  1 , Keishi Ichikawa  1 , Ferdinand Flores  1 , Sajad Hamal  1 , David Feldman  3 , Matthew J Budoff  1
Affiliations
Observational Study

The impact of carbohydrate restriction-induced elevations in low-density lipoprotein cholesterol on progression of coronary atherosclerosis: the ketogenic diet trial study design

Denise Alison R Javier et al. Coron Artery Dis. .

Abstract

Background: Despite innovations in pharmacotherapy to lower lipoprotein cholesterol and apolipoprotein B, risk factors for atherosclerotic cardiovascular disease (ASCVD), ASCVD persists as the leading global cause of mortality. Elevations in low-density lipoprotein cholesterol (LDL-C) are a well-known risk factor and have been a main target in the treatment of ASCVD. The latest research suggests that ketogenic diets are effective at improving most non-LDL-C/apolipoprotein B cardiometabolic risk factors. However, ketogenic diets can induce large increases in LDL-C to >190 mg/dl in some individuals. Interestingly, these individuals are often otherwise lean and healthy. The influence of increased levels of LDL-C resulting from a carbohydrate-restricted ketogenic diet on the progression of atherosclerosis in otherwise metabolically healthy individuals is poorly understood. This observational study aims to assess and describe the progression of coronary atherosclerosis in this population within 12 months.

Methods: Hundred relatively lean individuals who adopted ketogenic diets and subsequently exhibited hypercholesterolemia with LDL-C to >190 mg/dl, in association with otherwise good metabolic health markers, were enrolled and observed over a period of 12 months. Participants underwent serial coronary computed tomography angiography scans to assess the progression of coronary atherosclerosis in a year.

Results: Data analysis shall begin following the conclusion of the trial with results to follow.

Conclusion: Ketogenic diets have generated debate and raised concerns within the medical community, especially in the subset exhibiting immense elevations in LDL-C, who interestingly are lean and healthy. The relationship between elevated LDL-C and ASCVD progression in this population will provide better insight into the effects of diet-induced hypercholesterolemia.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Schematic diagram of trial duration. CCTA, coronary computed tomography angiography; LDL-C, low-density lipoprotein cholesterol.
See this image and copyright information in PMC

References

    1. Libby P. The changing landscape of atherosclerosis. Nature 2021; 592:524–533. - PubMed
    1. Kohli-Lynch CN, Thanassoulis G, Moran AE, Sniderman AD. The clinical utility of apoB versus LDL-C/non-HDL-C. Clin Chim Acta 2020; 508:103–108. - PubMed
    1. Wang N, Woodward M, Huffman MD, Rodgers A. Compounding benefits of cholesterol-lowering therapy for the reduction of major cardiovascular events: systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2022; 15: e008552. - PubMed
    1. Dugani SB, Moorthy MV, Li C, Demler OV, Alsheikh-Ali AA, Ridker PM, et al. . Association of lipid, inflammatory, and metabolic biomarkers with age at onset for incident coronary heart disease in women. JAMA Cardiol 2021; 6:437–447. - PMC - PubMed
    1. Araújo J, Cai J, Stevens J. Prevalence of optimal metabolic health in American adults: National Health and Nutrition Examination Survey 2009–2016. Metab Syndr Relat Disord 2019; 17:46–52. - PubMed

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