J Appl Physiol (1985). 2025 Nov 25. doi: 10.1152/japplphysiol.00893.2025. Online ahead of print.
ABSTRACT
Adults with type 1 diabetes (T1D) are at a higher risk for cardiovascular disease (CVD) compared with the general population. HbA1c is the primary modifiable risk factor for CVD in T1D. However, fewer than 1% of patients achieve euglycemia (<5.7% HbA1c). Ketogenic diets (KD; ≤50g carbohydrate/day) could improve glycemia and reduce CVD risk in T1D by reducing HbA1c and insulin load. One gold-standard cardiovascular assessment - coronary artery calcification - has not yet been reported among individuals with T1D undergoing a KD. In T1D, 30-70% of males between the ages of 30-39 years old have CAC >1, which rapidly progresses to 70-90% between the ages of 40-49 years old, with male sex and elevated low-density lipoprotein (LDL-C) as predictors of CAC progression. Therefore, this case report aims to provide CAC scores from an individual who followed a KD for over 10 years for the first time. We collected this medical history information from the 33-year-old male case study participant with T1D following the KD for over 10 years without use of lipid-lowering medication. The participant achieved euglycemia with an HbA1c of 5.5%. High-resolution computed tomography (CT) imaging of the chest was performed, focusing on the coronary arteries. Scans were obtained using a 64-slice CT scanner equipped with coronary calcium quantification software. Analysis revealed a total Agatston calcium score of 0 across all coronary artery territories. These findings indicate an absence of detectable coronary artery calcification, suggesting the absence of atherosclerotic plaque formation despite concern about the long-term cardiovascular consequences of a KD.
PMID:41289606 | DOI:10.1152/japplphysiol.00893.2025