Evaluation of the most common parameters used to describe cardiovascular risk and the influence of ketogenic and Mediterranean diet

Abstract

Cardiovascular disease (CVD) stands as the leading global cause of mortality, underscoring the critical need for practical tools to assess CVD risk at an early stage. An accessible approach involves the evaluation of bloodwork alongside simple anthropometric measurements. This narrative review seeks to establish the appropriateness of common parameters used in the outpatient setting in assessing the risk of developing CVD. These parameters encompass bloodwork values employed to characterize insulin resistance (IR) and dyslipidemia, as well as anthropometric measurements used to describe issues related to overweight and fat distribution. A particular emphasis is placed on understanding how Mediterranean and ketogenic diets influence these parameters. In the realm of bloodwork, findings indicate that the triglycerides (TG) to high-density lipoproteins (HDL) ratio serves as a valuable tool for assessing both IR and dyslipidemia. Less emphasis should be placed on total cholesterol and low-density lipoproteins (LDL) because the existing literature lacks consistency and fails to establish a clear, direct correlation between cholesterol levels, CVD, and mortality. On the other hand, numerous studies consistently demonstrate a direct correlation between CVD, mortality, and the levels of small-dense LDL (sdLDL), which represent the oxidized form of LDL. Regarding anthropometric parameters, the body mass index (BMI) falls short in value as it neglects to consider fat distribution and lean mass. More informative are anthropometric parameters that account for a single measure of fat mass and another for lean mass, such as the waist-height ratio (WHtR) or the waist-hip ratio (WHR). Both Mediterranean and ketogenic diets demonstrate improvements across major parameters used to evaluate CVD and mortality risk. The ketogenic diet, in particular, yields superior results in most aspects, except cholesterol levels. Further studies are recommended to refine dyslipidemia characterization and its connection to health outcomes.