Summary of "Сенсационное исследование : бляшки в сосудах не связаны с высоким холестерином. Революция в науке!"
Scientific Concepts and Discoveries Presented
- Atherosclerotic Plaques and Cholesterol:
- A recent sensational study challenges the long-held belief that high levels of Low-Density Lipoprotein Cholesterol (LDL-C) and Apolipoprotein B (apoB) directly correlate with the formation and growth of Atherosclerotic Plaques.
- The study found no significant relationship between LDL-C/apoB levels and the progression of Atherosclerotic Plaques in people on a Ketogenic Diet with very high LDL-C but otherwise healthy metabolic profiles.
- However, individuals who already had plaques showed continued plaque growth, indicating existing plaques predict further progression regardless of LDL-C/apoB levels.
- Ketogenic Diet and Lipid Metabolism:
- The Ketogenic Diet is very low in carbohydrates, leading the body to use fat as the primary energy source, producing ketones (acetone, acetoacetate, beta-hydroxybutyrate).
- Some individuals on the keto diet, termed "lean hyper-responders," develop very high LDL-C levels despite being metabolically healthy, with low triglycerides and high HDL cholesterol.
- Possible mechanisms for high LDL-C in these individuals include:
- Increased synthesis of very low-density lipoproteins (VLDL) by the liver due to fat metabolism.
- Increased cholesterol synthesis triggered by high intake of saturated fats.
- Genetic variations causing enhanced intestinal cholesterol absorption and reduced excretion.
- Study Design and Limitations:
- The study involved 100 lean individuals on a Ketogenic Diet for at least 2 years with LDL-C >4.9 mmol/L but no genetic hypercholesterolemia.
- Coronary CT scans measured non-calcified (soft) plaque volume at baseline and after one year.
- No control group with normal LDL-C was included, limiting the generalizability of results.
- The study was not randomized and lasted only one year, whereas atherosclerosis typically develops over decades.
- The initially registered primary endpoint (change in total plaque volume) was not fully reported, raising concerns about data transparency.
- Despite claims that LDL-C/apoB levels do not affect plaque progression, further analysis showed an average plaque volume increase of 18.8 mm³/year in the cohort, which is significant and comparable to or worse than some high-risk groups (e.g., people with diabetes).
- Implications and Critique:
- The study’s conclusions have been widely misinterpreted on social media to suggest that high LDL-C is harmless on a keto diet, which is misleading and potentially dangerous.
- High LDL-C and apoB remain significant risk factors for cardiovascular disease.
- The study highlights the complexity of lipid metabolism and cardiovascular risk in keto diet followers but does not overturn decades of evidence linking LDL-C to atherosclerosis.
- The lack of a control group and short duration limit the study’s ability to definitively assess risk.
- Practical Recommendations:
- Keto diet can be beneficial for some, especially those with autoimmune diseases or metabolic conditions, but LDL-C and apoB levels must be monitored regularly.
- Replacement of animal saturated fats with vegetable fats (e.g., olive oil, nuts, fatty fish) is advised to manage cholesterol levels.
- Regular lipid profiling (lipidogram), blood pressure monitoring, physical activity, and avoiding insulin resistance are critical for cardiovascular health.
- Awareness that cardiovascular disease can present suddenly and fatally without prior symptoms underscores the need for proactive monitoring.
Methodology of the Study
- Selection Criteria:
- 100 lean individuals on keto diet for ≥2 years.
- LDL-C levels >4.9 mmol/L without genetic hypercholesterolemia.
- Metabolically healthy (no diabetes, hypertension, or cardiovascular disease).
- Measurements:
- Coronary computed tomography (CT) scans at baseline and after 1 year.
- Focus on volume of non-calcified (soft) Atherosclerotic Plaques.
- Study Design:
- Observational cohort study, not randomized controlled trial.
- No control group included.
- Registered primary endpoint was total plaque volume change, but this data was not fully published.
Researchers and Sources Featured
- The study was published in the Journal of the American Heart Association.
- The research was conducted at the Lungvist Research Institute.
- The video references ongoing discussions and critiques on English-language Twitter and YouTube.
- The author of the video (unnamed) corresponded with one of the study’s authors to clarify some findings.
- Historical references to Ketogenic Diet research from the 1920s (epilepsy treatment) and the 1960s Atkins Diet.
Summary
A recent high-profile study on keto diet followers with very high LDL-C challenges the direct link between LDL-C/apoB and atherosclerotic plaque growth but suffers from methodological limitations and incomplete data reporting. While the study
Category
Science and Nature
