Keto Diet May Not Increase Heart Disease Risk Despite Higher LDL: Study Finds - Video

A new study has concluded that the spike in LDL cholesterol often seen in people on the ketogenic diet does not necessarily increase their risk of heart disease—provided they are otherwise metabolically healthy.

Published in the Journal of the American College of Cardiology: Advances, the research followed 100 adults classified as Lean Mass Hyper-Responders (LMHRs), individuals who experience significant increases in LDL and apolipoprotein B (ApoB) levels while on a ketogenic diet. Despite these elevated markers, participants maintained healthy blood pressure, low triglycerides, low body fat, low insulin resistance, and high HDL (“good” cholesterol) over the course of one year.

The study found no link between the increased cholesterol and heart disease risk in these individuals. Instead, the presence of pre-existing arterial plaque was identified as a more accurate predictor of future cardiovascular issues—suggesting that baseline heart health matters more than cholesterol levels alone in otherwise healthy individuals following a keto diet.

This challenges the long-standing belief that LDL levels alone should dictate cardiovascular risk, and supports a more nuanced, personalized approach to heart health assessments, especially in people adhering to low-carb, high-fat diets.

While the ketogenic diet has shown promise in areas such as epilepsy management, Alzheimer’s prevention, and even enhancing chemotherapy, it has also drawn criticism—most notably for its environmental impact and potential links to type 2 diabetes risk. However, this latest study offers reassurance for keto followers who are metabolically healthy but concerned about cholesterol.

Reference: Soto-Mota, A., Norwitz, N. G., Manubolu, V. S., Kinninger, A., Wood, T. R., Earls, J., ... & Budoff, M. (2025). Plaque Begets Plaque, ApoB Does Not: Longitudinal Data From the KETO-CTA Trial. JACC: Advances, 101686.