2型糖尿病（T2D）已被称为a cardiovascular diseasefor good reason. The risk of cardiovascular disease is 2-4 times greater in people with T2D, and cardiovascular reasons are the number one cause of death among those with the disease.
Lowering blood sugar, however, seems to reduce risk. The UK Prospective Diabetes Study showed that every 1% lower HbA1c reduced the risk of heart attack by14%, and although differences in HbA1c between the intensive and standard treatment groups were lost after the first year, the reduction in risk of heart attack and death persisted十年，表明短期改善血糖对新诊断的糖尿病患者的持久作用。但是，用药物降低葡萄糖过多，以至于严重的降血糖（低血糖）事件可能具有negative effects。
为了tunately, diabetes treatment has come a long way.GLP-1受体激动剂和SGLT2抑制剂提供改良的血糖控制，低血糖风险低，心血管事件的风险降低。现在，存在大量证据表明营养al approaches, like aketogenic饮食，反向糖尿病（即，降低葡萄糖和分离药物的过程），甚至将糖尿病放入缓解通过将血糖返回到糖尿病上，而无需药物。
Taken together, evidence suggests that improved glucose outcomes and diabetes remission from nutritional approaches could also favorably impact cardiovascular disease and events. The lower carbohydrate and higher fat Mediterranean diet is the only nutritional approach with evidence of a reduced risk of actual cardiovascular events (like a heart attack or stroke) or deaths related to a cardiovascular cause in both primary and secondary prevention, coming from thepredimed和Lyon Diet Heart研究分别。
来自非常低的碳水化合物饮食的研究导致营养酮症，就像我们一样出版于Cardiovascular Diabetology，目前依靠心血管风险的替代标记。尽管大多数标记有所改善，但一些研究观察到LDL-C的增加，这一直是心血管风险管理的基石。
虽然考虑了LDL因果在动脉粥样硬化中，在临床实践中不能忽略，也不能仅仅为风险评估提供信息，因为LDL-C通常可以是不和谐与LDL颗粒的数量。实际上，计算出的风险评分以帮助临床医生判断风险通常不包括LDL-C，而是依靠几个其他标记of risk like total cholesterol, HDL-C, and blood pressure.
动脉粥样硬化的过程是梯度驱动的，并且反映了粒子数量（如LDL粒子和APOB），而非HDL-C则比LDL-C更好地具有风险标记，并且包括在实践中。guidelines。正如我们观察到的那样，这些标记通常不会因生酮饮食而改变。我们还发现，颈动脉壁的厚度是动脉粥样硬化的另一个标记，未受影响。
Even when LDL-C lowering is achieved through statin treatment, residual risk can remain from high triglycerides, low HDL-C, and more small LDL particles. This constellation of characteristics is referred to as the atherogenic lipoprotein profile (ALP), and it is the most common dyslipidemia in patients with T2D. The ALP was normalized in a significant proportion of patients advised to consume a very low carbohydrate diet over 2 years in this research study. Other risk factors for cardiovascular disease like obesity and inflammation improved; most patients lowered HbA1c and some put diabetes in缓解。
我们的研究表明，包括营养酮症在内的非常低的碳水化合物饮食可导致大量心血管危险因素改善。这与LDL颗粒数和颈动脉内膜介质厚度无变化，这表明心血管安全以及T2D逆转到降低血糖水平，甚至到缓解点。
我们的研究表明，包括营养酮症在内的非常低的碳水化合物饮食可导致大量心血管危险因素改善。
The impact of nutritional ketosis on cardiovascular outcomes like heart attack, stroke, and hospitalization or death from a cardiovascular cause, however, remains an open question. The evidence certainly points in the right方向, and this coupled with the reversal of diabetes seems like a win-win.
想象一下，使用生酮营养疗法进行强化疗法，在新诊断的T2D患者中进行了为期10年的试验，以及我们可以从初级预防中学到的知识。想象一下，针对生酮营养疗法的心力衰竭的患者进行了一项试验，以及我们可以从入院风险中学到的知识。
So, are we willing to let PREDIMED and the Lyon Diet Heart Study be the last cardiovascular outcome trials in nutrition? Or are we ready to put this intervention of a very low carbohydrate diet including nutritional ketosis with sustained, long-term benefits to the test?
我们的患者应该知道。
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