The "lean mass hyper-responder" phenotype (lean individuals on a ketogenic diet with elevated LDL) is associated with faster-than-expected arterial plaque progression.

noli's read

The advice is based on the results of the 'Keto-CTA' study, a prospective observational study (JACC Advances, 2025) that followed 100 participants. While the researchers noted heterogeneous progression, subsequent critical analyses and experts have highlighted that the observed progression, particularly in non-calcified plaque volume, was faster than what would be expected in metabolically healthy individuals. The study was also criticized for the omission of certain pre-registered initial results, which fueled an intense scientific debate. It is important to note that while LDL-C and ApoB were very high in these subjects, the study did not find a direct correlation between these lipid levels and the rate of plaque progression, suggesting that other factors may be at play. In summary, the statement is firmly anchored in the observed data from this specific study, while remaining at the center of a controversy regarding the interpretation of long-term cardiovascular risks in this particular group.

the sources

No named source held this one up — that absence is part of the verdict.