Hi Dave — thank you for the kind words on our NATURE-CT publication. You asked a fair question: how would Keto-CTA look if we only looked at the people with CAC ≤ 100, just like we did in NATURE-CT? Any comparison using the original KETO-CTA data is no longer valid. The paper was formally retracted by JACC Advances at the authors’ own request. The retraction notice is here: jacc.org/doi/10.1016/j.jacad… Even setting the retraction aside, the plaque progression rates in the keto/LMHR group were much higher than the healthy rates we reported in NATURE-CT: ~18.9 mm³ median NCPV increase vs ~4.9 mm³ annualized in NATURE-CT. This faster plaque progression is the adverse effect directly linked to the very high ApoB/LDL-C levels caused by the keto diet. The public should be warned that this is likely a dangerous approach, especially for those who show rapid plaque progression as defined by OUR study. Standard of care guidelines from the ACC and AHA recommend lowering ApoB and LDL-C to reduce heart disease risk. They advise against allowing sustained high levels like those seen in keto dieters. Caution is essential. We can now define and treat rapid progressors even before calcium is present, as documented in our First-in-Human paper: jacc.org/doi/10.1016/j.jacca… This is further supported by performing serial imaging—an approach we first described in 2013 in Atherosclerosis: atherosclerosis-journal.com/… We subsequently confirmed this over 13 years using current technology in our 2022 paper on serial analysis of coronary artery disease progression by AI-assisted coronary CT angiography: pubmed.ncbi.nlm.nih.gov/3643… We all agree that baseline plaque strongly predicts future plaque. But decades of research also show that sustained high ApoB/LDL-C drives atherosclerosis progression. In this group who chose the keto diet often against "standard of evidence advise", close lipid monitoring and careful risk assessment are essential. Keto is likely harmful to arteries for most people, even if some tolerate it well. Looking forward to continuing open discussion. Best Ron Karlsberg MD FACP FAHA FACC MSCCT (Lead author, NATURE-CT)@realDaveFeldman @DLBHATTMD @MichaelAlbertMD @CMichaelGibson @RonBlankstein @chamath @ethanjweiss