Longitudinal Data From the KETO-CTA Study: Plaque Predicts Plaque, ApoB Does Not

Area of Science:

• Cardiovascular Medicine
• Nutritional Science
• Metabolic Health

Background:

• Ketogenic diets (KD) induce heterogeneous changes in low-density lipoprotein cholesterol (LDL-C).
• Previous research noted an inverse link between body mass index and LDL-C changes on KD.
• The cardiovascular implications of these lipid alterations remain unclear.

Purpose of the Study:

• To investigate the association between plaque progression and its predictors in individuals with elevated LDL-C on a KD.
• To determine if Apolipoprotein B (ApoB) and LDL-C levels predict atherosclerosis progression.

Main Methods:

• A one-year follow-up study of 100 individuals with KD-induced LDL-C ≥190 mg/dL.
• Coronary artery calcium and CT angiography were used to assess plaque.
• Linear regression and Bayes factors analyzed plaque progression predictors.

Main Results:

• Baseline high ApoB and LDL-C did not correlate with changes in noncalcified plaque volume (NCPV) or total plaque score (TPS).
• Neither ApoB changes nor total LDL-C exposure predicted plaque progression.
• Bayesian analysis favored the null hypothesis, indicating no association between ApoB and plaque progression.
• Baseline plaque characteristics strongly predicted subsequent NCPV changes.

Conclusions:

• In lean, healthy individuals on KD, ApoB and LDL-C levels/changes did not drive plaque progression.
• Existing plaque burden is a significant predictor of future plaque progression in this population.
• Findings suggest that in this context, 'plaque begets plaque,' rather than ApoB driving progression.