A new study published in the Journal of the American College of Cardiology found that otherwise “metabolically healthy” individuals on a ketogenic diet may not need cholesterol-lowering statin medications – even if their “bad” cholesterol numbers are elevated.
Statins have proven remarkably effective in lowering the level of low-density lipoprotein cholesterol (LDL-C). This “bad” cholesterol has long been considered a risk factor for heart disease, the leading cause of death in the United States.
Because they work so well, statins are the drug of choice for treating hyperlipidemia, a condition characterized by high levels of lipids or fats in the blood, and for preventing or reducing cardiovascular disease. According to the National Institutes of Health (NIH), more than 47 million American adults take a statin every day, making it the most commonly prescribed class of medications in the U.S., and another 47 million could benefit from taking statins.
Jonathan Fialkow, M.D.- chief medical executive of Population Health, Value and Primary Care for Baptist Health.
Is Low-Density Lipoprotein Cholesterol Really That Bad?
“The new study indicates that there may be a number of patients with high levels of LDL-C for whom statin therapy may not actually be necessary,” says cardiologist Jonathan Fialkow, M.D., chief medical executive of Population Health, Value and Primary Care for Baptist Health, deputy director of clinical cardiology at Baptist Health Miami Cardiac & Vascular Institute, and chief of cardiology services at Baptist Health Baptist Hospital. “High LDL might not be the risk for heart disease we thought it would be.”
In the study, “Carbohydrate Restriction-Induced Elevations in LDL-Cholesterol and Atherosclerosis: The KETO Trial,” researchers examined 80 people with an average age of 55 who were on a low-carbohydrate/high-protein ketogenic (KETO) diet for nearly five years and had a particular response creating very high LDL-cholesterol levels. This cohort was compared to 80 people enrolled in the Miami Heart Study who were not on a special diet and had average to mildly elevated cholesterol levels.
High LDL-C Levels Don’t Always Increase Coronary Plaque
Dr. Fialkow, one of the original Miami Cardiac & Vascular Institute investigators in the Miami Heart Study, says the new study shows that for “metabolically healthy individuals on a ketogenic diet,” high LDL-C levels may not necessarily equate with increased coronary plaque buildup or heart disease.
“The study found no increased progression in either group. They had the same level of disease risk,” Dr. Fialkow says. “As long as you don’t consume lots of sugar and carbs, you may not be at risk for heart disease, even if you have high cholesterol.”
Dr. Fialkow cautions that you should consult with your healthcare provider before making any dietary changes, especially if you have existing cardiovascular risk factors. “Anyone with high cholesterol or a genetic predisposition to heart disease should work with a doctor early on to develop a personalized approach to prevention,” he says.
The study’s finding challenges traditional views and highlights the importance of personalized care, Dr. Fialkow notes. “Doctors should not ignore high levels of LDL-C when treating patients but they now know other factors should be considered before prescribing medications.”
