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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. To investigate the association between LCHF dietary patterns, lipid levels and incident major adverse cardiovascular events (MACE). In a cohort from the UK Biobank, participants with ≥ one 24-hour dietary questionnaire were identified. A LCHF diet was defined as 45% TDE 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. From 2034 LCHF and 8136 SD identified participants, 305 LCHF and 1220 SD individuals completed an enrollment assessment concurrently with lipids collection. In this cohort, low-density lipoprotein-cholesterol (LDL-C) and apolipoprotein B (apoB) levels were significantly increased in the LCHF vs SD group (p5 mmol/L, p<0.001). After 11.8 years, 9.8% LCHF vs 4.3% participants experienced a MACE (p<0.001). This difference remained significant after adjustment for cardiovascular risk factors (HR 2.18, 95% CI 1.39-3.43, p<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. Consumption of a LCHF diet was associated with increased LDL-C and apoB, and an increased risk of incident MACE.
Iatan et al. (Mon,) studied this question.