Statin therapy is not warranted for a person with high LDL-cholesterol on a low-carbohydrate diet

Abstract

Purpose of reviewAlthough there is an extensive literature on the efficacy of the low carbohydrate diet (LCD) for weight loss and in the management of type 2 diabetes, concerns have been raised that the LCD may increase cardiovascular disease (CVD) risk by increasing the level of low-density lipoprotein cholesterol (LDL-C). We have assessed the value of LDL-C as a CVD risk factor, as well as effects of the LCD on other CVD risk factors. We have also reviewed findings that provide guidance as to whether statin therapy would be beneficial for individuals with high LDL-C on an LCD. Recent findingsMultiple longitudinal trials have demonstrated the safety and effectiveness of the LCD, while also providing evidence of improvements in the most reliable CVD risk factors. Recent findings have also confirmed how ineffective LDL-C is in predicting CVD risk. SummaryExtensive research has demonstrated the efficacy of the LCD to improve the most robust CVD risk factors, such as hyperglycemia, hypertension, and atherogenic dyslipidemia. Our review of the literature indicates that statin therapy for both primary and secondary prevention of CVD is not warranted for individuals on an LCD with elevated LDL-C who have achieved a low triglyceride/HDL ratio. Keywords atherogenic dyslipidemia, carbohydrate restriction, cardiovascular disease, insulin-resistant phenotype, ketogenic diet, metabolic syndrome, obesity '.. there are things we know we know. We also know there are known unknowns; that is to say, we know there are some things we do not know.'

Prolonged remission followed by low insulin requirements in a patient with type 1 diabetes on a very low-carbohydrate diet

“…Management of raised LDL-C in individuals adhering to LCDs remains a contentious field, however a growing body of evidence suggests that a default to a statin prescription purely due to a high LDL value, which is independent of a genetic/familial predisposition, may not be appropriate. Indeed, a more comprehensive understanding of LCDs and lipidology has revealed that statin therapy in individuals on an LCD with elevated LDL-C and non-atherogenic lipid profiles (low triglyceride–HDL-C ratios) may not be warranted for primary and secondary prevention of cardiovascular disease ( 15 ). Further research in the form of randomised controlled trials, specifically investigating the long-term effects of CHO-reduction on T1DM lipid profiles is certainly warranted, with an emphasis on cardiovascular outcomes.…”

Opinion: Are mental health benefits of the ketogenic diet accompanied by an increased risk of cardiovascular disease?

“…It is therefore important to recognize that the primary reason why LDL-C is a poor marker for CVD risk is because it is a hybrid measure, composed of different sizes of LDL particles (sdLDL and lbLDL), as well as Lp(a) (discussed previously), each with a different association to metabolic health and CVD risk ( 90 , 95 ) [see also Gjuladin-Hellon et al ( 96 ) and Diamond et al ( 97 ) for related review and discussion].…”

Historical Review of the Use of Relative Risk Statistics in the Portrayal of the Purported Hazards of High LDL Cholesterol and the Benefits of Lipid-Lowering Therapy

“…Hence, the pejorative view of LDL-C as the “bad cholesterol,” which has been perpetuated by the disproportionate emphasis on RR statistics, is not supported by a balanced review of the literature. The characteristic of this perspective is the opinion that “evidence falsifying the hypothesis that LDL drives atherosclerosis has been largely ignored” [ 134 ], and the opinion of three cardiologists that “LDL cholesterol risk has been exaggerated” [ 135 ] (see also Ravnskov et al [ 34 ] and Diamond et al [ 136 ] for related reviews and discussion).…”