Heart disease is the No. 1 killer of Americans. However, having high cholesterol levels doesn’t always lead to heart disease, a South Florida cardiac specialist has discovered.
Dr. Jonathan Fialkow, deputy director of clinical cardiology at Baptist Health Miami Cardiac & Vascular Institute, said a study of 80 people on the KETO diet for nearly five years found that high levels of low-density lipoprotein cholesterol, LDL-C (often referred to as bad cholesterol), didn’t always lead to coronary plaque buildup or heart disease.
“This is because they (participants on the KETO diet) are metabolically healthy,” Fialkow said. “This shows that high LDLs might not be the risk for heart disease we thought it would be.”
This study, published in the American College of Cardiology Journal, compared 80 people with an average age of 55 on low-carb/high-protein and fat diets with 80 people enrolled in a Miami heart study and not on a special diet.
“They had the same level of disease risk,” Fialkow said. “The study found no increased progression in either group.”
Researchers concluded there was no association between cholesterol levels and plaque burden in either group. So, as long as people do not consume lots of sugar and carbohydrates, they may not be at risk for heart disease, even if they have high cholesterol.
The results could influence how doctors approach cholesterol management in patients, Fiaklow said. Doctors should not ignore high levels of LDL when treating patients, but they now know other factors should be considered before prescribing medications.
“Patient risk assessment should be personalized and precise,” Fialkow said. “The pushback comes from generations who believe fat is bad and cholesterol is bad, but that is not substantiated by evidence,” he said. “The results challenge the conventional wisdom of these markers being predictors of heart disease.”
Researchers note that lipid-lowering medications, including statins, have been effective in reducing heart attacks in high-risk populations. However, they highlighted that most of the clinical trials involving treatments included patients mostly considered “metabolically unhealthy.”
Fialkow said he had a significant role in the Miami heart study and supplied the data to UCLA researchers who conducted the KETO study. “I keep the data clean and partner with academics,” he said.
As a South Florida cardiac specialist, Fialkow said anyone with high cholesterol or a genetic predisposition to heart disease should work with a doctor “early in the trajectory of a chronic disease” to develop a personalized approach to prevention.
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