Coronary artery calcification in type 1 diabetes after 10-year ketogenic diet

Adults with type 1 diabetes (T1D) are at a higher risk for cardiovascular disease (CVD) compared with the general population. Hemoglobin A1c (HbA1c) is the primary modifiable risk factor for CVD in T1D. However, fewer than 1% of patients achieve euglycemia (<5.7% HbA1c). Ketogenic diets (KDs; ≤50 g carbohydrate/day) could improve glycemia and reduce CVD risk in T1D by reducing HbA1c and insulin load. One gold-standard cardiovascular assessment-coronary artery calcification-has not yet been reported among individuals with T1D undergoing a KD. In T1D, 30-70% of males between the ages of 30-39 yr old have coronary artery calcification (CAC) >1, which rapidly progresses to 70-90% between the ages of 40-49 yr old, with male sex and elevated low-density lipoprotein cholesterol (LDL-C) as predictors of CAC progression. Therefore, this case report aims to provide CAC scores from an individual who followed a KD for over 10 years for the first time. We collected this medical history information from the 33-yr-old male case study participant with T1D following the KD for over 10 years without the use of lipid-lowering medication. The participant achieved euglycemia with an HbA1c of 5.5%. High-resolution computed tomography (CT) imaging of the chest was performed, focusing on the coronary arteries. Scans were obtained using a 64-slice CT scanner equipped with coronary calcium quantification software. Analysis revealed a total Agatston calcium score of 0 across all coronary artery territories. These findings indicate an absence of detectable coronary artery calcification, suggesting the absence of atherosclerotic plaque formation despite concern about the long-term cardiovascular consequences of a KD.NEW & NOTEWORTHY In males with type 1 diabetes (T1D), 30-70% have a coronary artery calcification (CAC) score >1 in their thirties. The data in this case report indicate zero detectable CAC in a 30-39-yr-old male with T1D who followed a ketogenic diet for 10 years despite having an elevated low-density lipoprotein and no lipid-lowering medication. This suggests an absence of atherosclerotic plaque formation, despite concerns about the long-term cardiovascular consequences of a ketogenic diet.