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). The investigator proposes to measure subclinical atherosclerosis as measured by low-dose prospective ECG-triggered cardiac computed tomographic angiography (CCTA) - in order to evaluate the rates of progression of atherosclerosis over 1 year. These participants will have voluntarily been eating a very low carbohydrate or ketogenic diet (VLC/KD) for at least 24 months, with evidence of significant elevations in LDL-C after commencing the diet.~Participants will be recruited online through social media including Facebook groups discussing VLC/KDs. The target population are those who experience significant increases in LDL-C on VLC/KDs whilst also being healthy and relatively lean (BMI <30mg/kg2 and waist circumference <102 cm and 88 cm for men and women respectively if BMI 25-30 mg/kg2).~Once participants present their interest to participate in the study by responding to the social media flyer and made an attempt to get in touch with the study site, study staff will reach out to the participant over the phone using an IRB (Institutional Review Board) approved screening questionnaire to verify eligibility and answer any question about the study. Once subject confirms that he/she is interested to participate, they will be informed that a copy of the Informed Consent Form (ICF) will be emailed to them using a HIPAA compliant DocuSign (application to sign a document electronically) portal. Subjects are required to review and electronically sign the ICF. Once an ICF has been signed, subject will be asked to upload the relevant medical records to the HIPAA compliant RedCap portal as documentary evidence to the lipid levels. Once the study team reviews the medical records/lab results and confirm the subject eligibility, the travel arrangements to the study site for the in-person baseline visit will be made.~Study participants will have total of 2 in-person study visits (Baseline - visit 1 and 12 month - visit 2) and will have a 6 month - phone visit in between.~During the baseline site visit, the participants will be asked to take a genetic test, blood draw, ECG and CCTA. Study staff will also be collecting vital signs, medical history, physical exam and questionnaire. Study participants will be asked to measure their morning blood ketone and glucose levels every day and report the results using KetoMojo application.~Subjects will be informed about the possible risk associated with the study participation including radiation from the CT scan/CCTA, risks associated with the taking Beta-blocker, Calcium channel blocker, Nitroglycerin as well as IV insertion.~Recruitment will take place over 6 months, with follow up over 12 months. The study design calls for the enrollment of 100 eligible subjects.
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).