Association of a Low-Carbohydrate High-Fat Diet With Plasma Lipid Levels and Cardiovascular Risk

Jul 31, 2024JACC. Advances

Links Between a Low-Carb High-Fat Diet, Blood Fats, and Heart Disease Risk

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Abstract

Consumption of a low-carbohydrate high-fat diet is associated with a significant increase in LDL-C levels and a higher risk of major adverse cardiovascular events.

In a cohort of 2034 individuals on a low-carbohydrate high-fat diet, LDL-C levels were significantly higher compared to 8136 individuals on a standard diet.
11.1% of participants on the low-carbohydrate high-fat diet experienced severe hypercholesterolemia, compared to 6.2% of those on a standard diet.
After an average follow-up of 11.8 years, 9.8% of those on a low-carbohydrate high-fat diet experienced a major adverse cardiovascular event, compared to 4.3% of the standard diet group.
The increased risk of major adverse cardiovascular events remained significant after adjusting for cardiovascular risk factors, with a hazard ratio of 2.18.
Individuals with a higher polygenic risk score for LDL-C showed the most pronounced increases in LDL-C levels on a low-carbohydrate high-fat diet.

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BACKGROUND: Low-carbohydrate high-fat (LCHF) diets have attracted interest for a variety of conditions. In some individuals, these diets trigger hypercholesterolemia. There are limited data on their effects on cardiovascular disease risk.

OBJECTIVES: The purpose of this study was to investigate the association between LCHF dietary patterns, lipid levels, and incident major adverse cardiovascular events (MACE).

METHODS: In a cohort from the UK Biobank, participants with ≥1 24-hour dietary questionnaire were identified. A LCHF diet was defined as <100 g/day and/or <25% total daily energy from carbohydrates/day and >45% total daily energy from fat, with participants on a standard diet (SD) not meeting these criteria. Each LCHF case was age- and sex-matched 1:4 to SD individuals.

RESULTS: Of the 2034 LCHF and 8136 SD identified participants, 305 LCHF and 1220 SD individuals completed an enrollment assessment concurrently with lipid collection. In this cohort, low-density lipoprotein-cholesterol (LDL-C) and apolipoprotein B levels were significantly increased in the LCHF vs SD group ( < 0.001). 11.1% of LCHF and 6.2% of SD individuals demonstrated severe hypercholesterolemia (LDL-C >5 mmol/L, < 0.001). After 11.8 years, 9.8% of LCHF vs 4.3% of SD participants experienced a MACE ( < 0.001). This difference remained significant after adjustment for cardiovascular risk factors (HR: 2.18, 95% CI: 1.39-3.43, < 0.001). Individuals with an elevated LDL-C polygenic risk score had the highest concentrations of LDL-C on a LCHF diet. Similar significant changes in lipid levels and MACE associations were confirmed in the entire cohort and in ≥2 dietary surveys. P P P P

CONCLUSIONS: Consumption of a LCHF diet was associated with increased LDL-C and apolipoprotein B levels, and an increased risk of incident MACE.

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Association of a Low-Carbohydrate High-Fat Diet With Plasma Lipid Levels and Cardiovascular Risk

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