Low carbohydrate/ketogenic diet in the optimization of lipoprotein(a) levels: do we have sufficient evidence for any recommendation?

ncreased lipoprotein (a) [Lp(a)] concentration is a documented risk factor for atherosclerotic cardiovascular disease (ASCVD), independ ent of LDL-cholesterol (LDL-C).1 Moreover, elevated Lp(a) levels have been recently shown to increase the risk of all-cause and cardio vascular mortality in the general population and ASCVD patients.2 The relationship between Lp(a) concentration and the risk of mortality is linear. It was shown that each 50 mg/dL (∼125 nmol/L) increase in Lp(a) concentration was associated with a 31% and 15% higher risk of ASCVD mortality in the general population and in patients with already established ASCVD.2 Increased Lp(a) levels are diagnosed in a significant proportion of people. According to the National Heart Lung and Blood Institute, an estimated 1.4 billion people globally have Lp(a) concentrations ≥50 mg/dL (≥125 nmol/L) with a prevalence ran ging from 10% to 30%.1 In Europe, 20% of women and 20% of men have serum Lp(a) concentration >50 mg/dL (>125 nmol/L).3,4 It is recom mended that serum Lp(a) concentration, both fasted and fed, should be lower than <50 mg/dL (<125 nmol/L), and some scientific societies suggest even <30 mg/dL (<75 nmol/L).3,4