Diet-induced Elevations in LDL-C and Progression of Atherosclerosis

This is an observational study examining the progression of subclinical coronary atherosclerosis in healthy participants who have an elevated LDL-C (above 190mg/dl) secondary to diet not associated with genetic familial hypercholesterolemia (FH). This study participants are classified to be Lean-Mass-Hyper-Responder (LMHR).

Inclusion Criteria:Age ≥ 18 years oldHad an LDL cholesterol of 160 mg/dL or below from most recent labs taken before adopting a low carb diet (requires documentary evidence)Has seen an increase of LDL cholesterol to 190 mg/dL or above from most recent labs on current diet **Has LDL cholesterol levels at least 50% or greater compared to most recent documented value prior to starting the diet.On low carb, ketogenic diet for the last 24 months or more.HDL-C ≥ 60 mg/dL and triglyceride level ≤ 80 mg/dL **Willingness to participate in the study and ability to sign informed consentIn the investigator's opinion subjects are willing and likely able to comply with scheduled visits, laboratory tests, and other study procedures.Normal to low BP (systolic ≤ 130 mm Hg or diastolic ≤ 80 mm Hg) at screening/baseline (visit 1).Fasting glucose < 110 mg/dL and HbA1c < 6.0%) **hsCRP < 2 mg/L **No prior diagnosis of Type 2 DiabetesNo prior use of anti-diabetic medicationNot currently taking lipid lowering supplements or medications including statins, red yeast rice, garlic, ezetemibe, berberineRequires documentary evidenceExclusion Criteria:Untreated hypothyroidism (TSH > 10)Use of medications that elevated LDL-C (anabolic steroids, isotretinoin, immunosuppressants, amiodarone, thiazide diuretics, glucocorticoids, or thiazolidinediones)PregnancyHas smoked more than 100 cigarettes in lifetimeAn ongoing inflammatory disorder (e.g. psoriatic arthritis)History of atherosclerotic heart diseaseKnown history of molecularly defined Familial HypercholesterolemiaBMI = or > 30 kg/m^2 (or waist circumference > 88 cm or > 102 cm for women and men respectively if BMI between 25-30 kg/m^2)Renal insufficiency (calculated creatinine clearance of <50 ml per minute, MDRD equation).Use of Lipid lowering medication (Statins, etc) at the time of most recent labs taken before starting Ketogenic diet.AST or ALT >2X the upper limit of normal (ULN) at the Screening visit (V1), or a total bilirubin >1.5X the ULN unless the subject has a history of Gilbert's.Subject unable to provide medical records indicating lab results before starting a keto- diet.Subject has a history of malignancy ≤5 years prior to signing informed consent, except for adequately treated basal cell or squamous cell skin cancer or in situ cervical cancer.Note (1) A subject with a history of malignancy >5 years prior to signing informed consent should have no evidence of residual or recurrent disease.Other severe acute or chronic medical or psychiatric condition or laboratory abnormality at the Screening visit (V1) that may increase the risk associated with trial participation or investigational product administration or may interfere with the interpretation of trial results and, in the judgment of the investigator, would make the subject inappropriate for entry into this trial.Subjects with known allergy to iodinated contrast materialSubject is pregnant or breast-feeding, or is expecting to conceive during the study period.