Low-Carbohydrate High-Fat “Keto-Like” Diet Associated With Increased Risk of CVD

A low-carbohydrate high-fat diet was associated with increased levels of LDL-C and apolipoprotein B (apoB) along with a twofold heightened risk of cardiovascular events, according to an observational study presented at ACC.23/WCC.

Analyzing data from the UK Biobank, Iulia Iatan, MD, PhD, et al., identified 305 participants whose responses to a one-time self-reported 24-hour diet questionnaire met their definition of a low-carbohydrate high-fat diet (LCHF): no more than 25% of total daily calories from carbohydrates and more than 45% from fat. Participants were then matched by age and sex with 1,220 individuals who reported a standard diet. The study population’s average age was 54 years, with 73% women and an average body mass index of 27.7 for those eating a LCHF diet and 26.7 for those eating a standard diet.

The study’s primary endpoint was to determine the impact of the LCHF diet on serum lipid levels. After an average of 11.8 years follow-up, researchers found that participants following the LCHF diet, when compared with those following a standard diet, had higher levels of LDL-C (3.80 vs. 3.64 mmol/L; p=0.004) and apoB (1.09 vs. 1.04 g/L; p<0.001).

A secondary endpoint explored the incidence of atherosclerotic cardiovascular disease events in both groups, where 9.8% of participants on a LCHF diet experienced a new cardiac event, compared with 4.3% of those on a standard diet (adjusted hazard ratio [HR], 2.18; 95% CI, 1.39-3.43; p<0.001).

Both the self-reported nature of the dietary data and the fact that participants only provided dietary information at one point in time are study limitations. Researchers also acknowledge that not everyone responds to a LCHF diet in the same way.

“On average, cholesterol levels tend to rise on this diet, but some people’s cholesterol concentrations can stay the same or go down, depending on several underlying factors,” Iatan states. “One of our next steps will be to try to identify specific characteristics or genetic markers that can predict how someone will respond to this type of diet.”

Clinical Topics: Prevention

Keywords: ACC Annual Scientific Session, ACC23, Secondary Prevention, ACC.23/WCC Meeting Newspaper, ACC Scientific Session Newspaper

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