Plaque Begets Plaque, ApoB Does Not

This groundbreaking study followed 100 lean, metabolically healthy individuals who developed very high LDL cholesterol levels (averaging 237 mg/dL) while following ketogenic diets for a year. Researchers used advanced heart imaging to track whether these elevated cholesterol levels led to increased arterial plaque buildup over time.

The key finding challenges conventional wisdom about cholesterol and heart disease risk. Despite having LDL cholesterol levels well above traditional "healthy" ranges, participants with elevated ApoB (a protein that carries cholesterol particles) and LDL cholesterol showed no increased plaque progression. The study used sophisticated statistical methods that were 6-10 times more likely to support the conclusion that ApoB levels don't drive plaque growth in this population.

However, the study revealed an important pattern: people who already had arterial plaque at the beginning of the study were much more likely to develop additional plaque over the year, regardless of their cholesterol levels. This "plaque begets plaque" phenomenon suggests that existing cardiovascular damage may be more predictive of future problems than cholesterol numbers alone.

This research has significant implications for personalized medicine approaches to cardiovascular risk assessment. It suggests that for metabolically healthy individuals following ketogenic diets, traditional cholesterol markers may not accurately predict heart disease progression, and that advanced imaging to detect existing plaque may provide more meaningful risk information than standard lipid panels alone.