{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:52:33Z","timestamp":1791075153799,"version":"4.1.0"},"reference-count":74,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"},{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cardiol Ther"],"DOI":"10.1007\/s40119-026-00478-0","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T07:22:26Z","timestamp":1790925746000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cardiovascular Outcomes Among Adults with Type 2 Diabetes or Obesity Receiving Carbohydrate-Reduced Nutrition via Telemedicine: A Retrospective Claims-Based Cohort Study"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0237-1038","authenticated-orcid":false,"given":"Caroline G. P.","family":"Roberts","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priya V.","family":"Shanmugam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaminie J.","family":"Athinarayanan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam J.","family":"Wolfberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Raskin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Lopez-Jimenez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,2]]},"reference":[{"key":"478_CR1","unstructured":"WHO. 2025. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/the-top-10-causes-of-death, Accessed 29 Sept 2025."},{"issue":"8","key":"478_CR2","doi-asserted-by":"publisher","first-page":"e41","DOI":"10.1161\/cir.0000000000001303","volume":"151","author":"SS Martin","year":"2025","unstructured":"Martin SS, Aday AW, Allen NB, et al. 2025 heart disease and stroke statistics: a report of US and global data From the American Heart Association. Circulation. 2025;151(8):e41\u2013660. https:\/\/doi.org\/10.1161\/cir.0000000000001303.","journal-title":"Circulation"},{"issue":"4","key":"478_CR3","doi-asserted-by":"publisher","first-page":"319","DOI":"10.3132\/dvdr.2008.046","volume":"5","author":"JC Fruchart","year":"2008","unstructured":"Fruchart JC, Sacks FM, Hermans MP, et al. The residual risk reduction initiative: a call to action to reduce residual vascular risk in dyslipidaemic patients. Diabetes Vasc Dis Res. 2008;5(4):319\u201335. https:\/\/doi.org\/10.3132\/dvdr.2008.046.","journal-title":"Diabetes Vasc Dis Res"},{"issue":"21","key":"478_CR4","doi-asserted-by":"publisher","first-page":"e984","DOI":"10.1161\/cir.0000000000000973","volume":"143","author":"TM Powell-Wiley","year":"2021","unstructured":"Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021;143(21):e984\u20131010. https:\/\/doi.org\/10.1161\/cir.0000000000000973.","journal-title":"Circulation"},{"issue":"3","key":"478_CR5","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2024.102402","volume":"49","author":"J Popiolek-Kalisz","year":"2024","unstructured":"Popiolek-Kalisz J. Ketogenic diet and cardiovascular risk\u2014state of the art review. Curr Probl Cardiol. 2024;49(3):102402. https:\/\/doi.org\/10.1016\/j.cpcardiol.2024.102402.","journal-title":"Curr Probl Cardiol"},{"key":"478_CR6","doi-asserted-by":"publisher","DOI":"10.1016\/s2468-2667(18)30135-x","author":"SB Seidelmann","year":"2018","unstructured":"Seidelmann SB, Claggett B, Cheng S, et al. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health. 2018. https:\/\/doi.org\/10.1016\/s2468-2667(18)30135-x.","journal-title":"Lancet Public Health"},{"issue":"4","key":"478_CR7","doi-asserted-by":"publisher","first-page":"874","DOI":"10.2337\/dc22-2310","volume":"46","author":"Y Hu","year":"2023","unstructured":"Hu Y, Liu G, Yu E, et al. Low-carbohydrate diet scores and mortality among adults with incident type 2 diabetes. Diabetes Care. 2023;46(4):874\u201384. https:\/\/doi.org\/10.2337\/dc22-2310.","journal-title":"Diabetes Care"},{"issue":"3","key":"478_CR8","doi-asserted-by":"publisher","DOI":"10.3390\/nu13030749","volume":"13","author":"AL McKenzie","year":"2021","unstructured":"McKenzie AL, Athinarayanan SJ, McCue JJ, et al. Type 2 diabetes prevention focused on normalization of glycemia: a two-year pilot study. Nutrients. 2021;13(3):749. https:\/\/doi.org\/10.3390\/nu13030749.","journal-title":"Nutrients"},{"key":"478_CR9","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2019.00348","volume":"10","author":"SJ Athinarayanan","year":"2019","unstructured":"Athinarayanan SJ, Adams RN, Hallberg SJ, et al. Long-term effects of a novel continuous remote care intervention including nutritional ketosis for the management of type 2 diabetes: a 2-year non-randomized clinical trial. Front Endocrinol. 2019;10:348. https:\/\/doi.org\/10.3389\/fendo.2019.00348.","journal-title":"Front Endocrinol"},{"key":"478_CR10","doi-asserted-by":"publisher","DOI":"10.1111\/dom.16525","author":"RN Adams","year":"2025","unstructured":"Adams RN, Athinarayanan SJ, Zoller AR, McKenzie AL, Ratner RE. Sustained metabolic improvements in a remotely delivered ketogenic nutrition programme for veterans with type 2 diabetes: a 3-year observational study. Diabetes Obes Metab. 2025. https:\/\/doi.org\/10.1111\/dom.16525.","journal-title":"Diabetes Obes Metab"},{"issue":"6","key":"478_CR11","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1016\/j.eprac.2025.03.013","volume":"31","author":"CCL Wang","year":"2025","unstructured":"Wang CCL, Estacio R, Coronel-Mockler S, et al. Virta Intervention in CommuniTies in cOloRado Pilot Study (VICTOR-Pilot), to Improve Diabetes and Cardiovascular Risk in Rural Communities Primary Results. Endocr Pr. 2025;31(6):790\u20137. https:\/\/doi.org\/10.1016\/j.eprac.2025.03.013.","journal-title":"Endocr Pr"},{"key":"478_CR12","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2024.0406","author":"HJ Willis","year":"2024","unstructured":"Willis HJ, Asche SE, McKenzie AL, et al. Impact of continuous glucose monitoring versus blood glucose monitoring to support a carbohydrate-restricted nutrition intervention in people with type 2 diabetes. Diabetes Technol Ther. 2024. https:\/\/doi.org\/10.1089\/dia.2024.0406.","journal-title":"Diabetes Technol Ther"},{"key":"478_CR13","doi-asserted-by":"publisher","DOI":"10.1016\/j.eprac.2025.05.746","author":"HJ Willis","year":"2025","unstructured":"Willis HJ, Asche SE, Adams RN, et al. Effects of continuous glucose monitoring versus blood glucose monitoring during a carbohydrate-restricted nutrition intervention in people with type 2 diabetes: 6-month follow-up outcomes from a randomized clinical trial. Endocr Pract. 2025. https:\/\/doi.org\/10.1016\/j.eprac.2025.05.746.","journal-title":"Endocr Pract"},{"issue":"1","key":"478_CR14","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-020-01178-2","volume":"19","author":"SJ Athinarayanan","year":"2020","unstructured":"Athinarayanan SJ, Hallberg SJ, McKenzie AL, et al. Impact of a 2-year trial of nutritional ketosis on indices of cardiovascular disease risk in patients with type 2 diabetes. Cardiovasc Diabetol. 2020;19(1):208. https:\/\/doi.org\/10.1186\/s12933-020-01178-2.","journal-title":"Cardiovasc Diabetol"},{"issue":"6","key":"478_CR15","doi-asserted-by":"publisher","DOI":"10.3390\/nu17060965","volume":"17","author":"D Dy\u0144ka","year":"2025","unstructured":"Dy\u0144ka D, Rodze\u0144 \u0141, Rodze\u0144 M, et al. Ketogenic diets for body weight loss: a comparison with other diets. Nutrients. 2025;17(6):965. https:\/\/doi.org\/10.3390\/nu17060965.","journal-title":"Nutrients"},{"issue":"3","key":"478_CR16","doi-asserted-by":"publisher","DOI":"10.3390\/nu15030500","volume":"15","author":"D Dy\u0144ka","year":"2023","unstructured":"Dy\u0144ka D, Kowalcze K, Ambrozkiewicz F, Paziewska A. Effect of the ketogenic diet on the prophylaxis and treatment of diabetes mellitus: a review of the meta-analyses and clinical trials. Nutrients. 2023;15(3):500. https:\/\/doi.org\/10.3390\/nu15030500.","journal-title":"Nutrients"},{"key":"478_CR17","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2025.1548609","volume":"12","author":"L Buchanan","year":"2025","unstructured":"Buchanan L, Calkins M, Kalayjian T, et al. TOWARD, a metabolic health intervention, demonstrates robust 1-year weight loss and cost-savings through deprescription. Front Nutr. 2025;12:1548609. https:\/\/doi.org\/10.3389\/fnut.2025.1548609.","journal-title":"Front Nutr"},{"key":"478_CR18","doi-asserted-by":"publisher","DOI":"10.1059\/0003-4819-153-5-201009070-00003","author":"TT Fung","year":"2010","unstructured":"Fung TT, van Dam RM, Hankinson SE, Stampfer M, Willett WC, Hu FB. Low-carbohydrate diets and all-cause and cause-specific mortality: two cohort Studies. Ann Intern Med Published online. 2010. https:\/\/doi.org\/10.1059\/0003-4819-153-5-201009070-00003.","journal-title":"Ann Intern Med Published online"},{"key":"478_CR19","first-page":"559","volume":"29","author":"C Strader","year":"2020","unstructured":"Strader C, Haskell T, Dierks M. Representativeness of Komodo claims and identification of patients with rare disease. Pharmacoepidemiol Drug Saf. 2020;29:559\u2013559.","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"478_CR20","unstructured":"Komodo Health. Homepage. Published 2020. https:\/\/www.komodohealth.com\/. Accessed 30 Sept 2025."},{"issue":"4","key":"478_CR21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2024.100852","volume":"3","author":"RG McCoy","year":"2024","unstructured":"McCoy RG, Swarna KS, Deng Y, et al. Derivation of an annualized claims-based major adverse cardiovascular event estimator in type 2 diabetes. JACC Adv. 2024;3(4):100852. https:\/\/doi.org\/10.1016\/j.jacadv.2024.100852.","journal-title":"JACC Adv"},{"issue":"8","key":"478_CR22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v042.i08","volume":"42","author":"DE Ho","year":"2011","unstructured":"Ho DE, Imai K, King G, Stuart EA. MatchIt: nonparametric preprocessing for parametric causal inference. J Stat Softw. 2011;42(8):1\u201328. https:\/\/doi.org\/10.18637\/jss.v042.i08.","journal-title":"J Stat Softw"},{"key":"478_CR23","unstructured":"Greifer N.. WeightIt: Weighting for covariate balance in observational studies. R package version 1.5.0. 2025. https:\/\/ngreifer.github.io\/WeightIt\/. Accessed 1 Oct 2025."},{"issue":"4","key":"478_CR24","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","volume":"61","author":"E Von Elm","year":"2008","unstructured":"Von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344\u20139. https:\/\/doi.org\/10.1016\/j.jclinepi.2007.11.008.","journal-title":"J Clin Epidemiol"},{"issue":"6","key":"478_CR25","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1161\/01.cir.99.6.779","volume":"99","author":"M de Lorgeril","year":"1999","unstructured":"de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction. Circulation. 1999;99(6):779\u201385. https:\/\/doi.org\/10.1161\/01.cir.99.6.779.","journal-title":"Circulation"},{"issue":"10338","key":"478_CR26","doi-asserted-by":"publisher","first-page":"1876","DOI":"10.1016\/s0140-6736(22)00122-2","volume":"399","author":"J Delgado-Lista","year":"2022","unstructured":"Delgado-Lista J, Alcala-Diaz JF, Torres-Pe\u00f1a JD, et al. Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial. Lancet. 2022;399(10338):1876\u201385. https:\/\/doi.org\/10.1016\/s0140-6736(22)00122-2.","journal-title":"Lancet"},{"issue":"25","key":"478_CR27","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1800389","volume":"378","author":"R Estruch","year":"2018","unstructured":"Estruch R, Ros E, Salas-Salvad\u00f3 J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med. 2018;378(25):e34. https:\/\/doi.org\/10.1056\/nejmoa1800389.","journal-title":"N Engl J Med"},{"issue":"22","key":"478_CR28","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1056\/nejmoa1212914","volume":"369","author":"RR Wing","year":"2013","unstructured":"The Look AHEAD Research Group, Wing RR, Bolin P, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. New Engl J Med. 2013;369(2):145\u201354. https:\/\/doi.org\/10.1056\/nejmoa1212914","journal-title":"New Engl J Med"},{"issue":"23","key":"478_CR29","doi-asserted-by":"publisher","first-page":"2489","DOI":"10.1001\/jama.2012.67929","volume":"308","author":"EW Gregg","year":"2012","unstructured":"The Look AHEAD Study Group, Gregg EW, Chen H, Wagenknecht LE, et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA. 2012;308(23):2489\u201396. https:\/\/doi.org\/10.1001\/jama.2012.67929.","journal-title":"JAMA"},{"issue":"6","key":"478_CR30","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/s2213-8587(14)70057-9","volume":"2","author":"G Li","year":"2014","unstructured":"Li G, Zhang P, Wang J, et al. Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention study: a 23-year follow-up study. Lancet Diabetes Endocrinol. 2014;2(6):474\u201380. https:\/\/doi.org\/10.1016\/s2213-8587(14)70057-9.","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"6","key":"478_CR31","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1016\/s2213-8587(19)30093-2","volume":"7","author":"Q Gong","year":"2019","unstructured":"Gong Q, Zhang P, Wang J, et al. Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance: 30-year results of the Da Qing Diabetes Prevention Outcome study. Lancet Diabetes Endocrinol. 2019;7(6):452\u201361. https:\/\/doi.org\/10.1016\/s2213-8587(19)30093-2.","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"22","key":"478_CR32","doi-asserted-by":"publisher","first-page":"1632","DOI":"10.1161\/circulationaha.121.056756","volume":"145","author":"RB Goldberg","year":"2022","unstructured":"Goldberg RB, Orchard TJ, Crandall JP, et al. Effects of long-term metformin and lifestyle interventions on cardiovascular events in the Diabetes Prevention Program and its outcome study. Circulation. 2022;145(22):1632\u201341. https:\/\/doi.org\/10.1161\/circulationaha.121.056756.","journal-title":"Circulation"},{"key":"478_CR33","doi-asserted-by":"publisher","DOI":"10.1016\/s2213-8587(25)00295-5","author":"EV Arreola","year":"2025","unstructured":"Arreola EV, Gong Q, Hanson RL, et al. Prediabetes remission and cardiovascular morbidity and mortality: post-hoc analyses from the Diabetes Prevention Program Outcome study and the DaQing Diabetes Prevention Outcome study. Lancet Diabetes Endocrinol. 2025. https:\/\/doi.org\/10.1016\/s2213-8587(25)00295-5.","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"10107","key":"478_CR34","doi-asserted-by":"publisher","first-page":"2050","DOI":"10.1016\/s0140-6736(17)32252-3","volume":"390","author":"M Dehghan","year":"2017","unstructured":"Dehghan M, Mente A, Zhang X, et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet. 2017;390(10107):2050\u201362. https:\/\/doi.org\/10.1016\/s0140-6736(17)32252-3.","journal-title":"Lancet"},{"issue":"1","key":"478_CR35","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-73384-x","volume":"14","author":"X Qu","year":"2024","unstructured":"Qu X, Huang L, Rong J. The ketogenic diet has the potential to decrease all-cause mortality without a concomitant increase in cardiovascular-related mortality. Sci Rep. 2024;14(1):22805. https:\/\/doi.org\/10.1038\/s41598-024-73384-x.","journal-title":"Sci Rep"},{"issue":"6","key":"478_CR36","doi-asserted-by":"publisher","first-page":"916","DOI":"10.1017\/s0007114514001627","volume":"112","author":"Y Nakamura","year":"2014","unstructured":"Nakamura Y, Okuda N, Okamura T, et al. Low-carbohydrate diets and cardiovascular and total mortality in Japanese: a 29-year follow-up of NIPPON DATA80. Br J Nutr. 2014;112(6):916\u201324. https:\/\/doi.org\/10.1017\/s0007114514001627.","journal-title":"Br J Nutr"},{"issue":"1","key":"478_CR37","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0055030","volume":"8","author":"H Noto","year":"2013","unstructured":"Noto H, Goto A, Tsujimoto T, Noda M. Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies. PLoS ONE. 2013;8(1):e55030. https:\/\/doi.org\/10.1371\/journal.pone.0055030.","journal-title":"PLoS ONE"},{"key":"478_CR38","doi-asserted-by":"publisher","DOI":"10.1016\/j.arr.2023.101997","volume":"90","author":"Z Ghorbani","year":"2023","unstructured":"Ghorbani Z, Kazemi A, Shoaibinobarian N, Taylor K, Noormohammadi M. Overall, plant-based, or animal-based low carbohydrate diets and all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective cohort studies. Ageing Res Rev. 2023;90:101997. https:\/\/doi.org\/10.1016\/j.arr.2023.101997.","journal-title":"Ageing Res Rev"},{"issue":"23","key":"478_CR39","doi-asserted-by":"publisher","first-page":"6277","DOI":"10.1080\/10408398.2021.1900057","volume":"62","author":"N Mohammadifard","year":"2022","unstructured":"Mohammadifard N, Mansourian M, Firouzi S, Taheri M, Haghighatdoost F. Longitudinal association of dietary carbohydrate and the risk cardiovascular disease: a dose-response meta-analysis. Crit Rev Food Sci Nutr. 2022;62(23):6277\u201392. https:\/\/doi.org\/10.1080\/10408398.2021.1900057.","journal-title":"Crit Rev Food Sci Nutr"},{"issue":"2","key":"478_CR40","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/j.clnu.2022.12.010","volume":"42","author":"P Qin","year":"2023","unstructured":"Qin P, Huang C, Jiang B, et al. Dietary carbohydrate quantity and quality and risk of cardiovascular disease, all-cause, cardiovascular and cancer mortality: a systematic review and meta-analysis. Clin Nutr. 2023;42(2):148\u201365. https:\/\/doi.org\/10.1016\/j.clnu.2022.12.010.","journal-title":"Clin Nutr"},{"issue":"6","key":"478_CR41","doi-asserted-by":"publisher","first-page":"1455","DOI":"10.1093\/ajcn\/71.6.1455","volume":"71","author":"S Liu","year":"2000","unstructured":"Liu S, Willett WC, Stampfer MJ, et al. A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women. Am J Clin Nutr. 2000;71(6):1455\u201361. https:\/\/doi.org\/10.1093\/ajcn\/71.6.1455.","journal-title":"Am J Clin Nutr"},{"issue":"19","key":"478_CR42","doi-asserted-by":"publisher","first-page":"1991","DOI":"10.1056\/nejmoa055317","volume":"355","author":"TL Halton","year":"2006","unstructured":"Halton TL, Willett WC, Liu S, et al. Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med. 2006;355(19):1991\u20132002. https:\/\/doi.org\/10.1056\/nejmoa055317.","journal-title":"N Engl J Med"},{"issue":"6","key":"478_CR43","doi-asserted-by":"publisher","DOI":"10.1007\/s11883-020-00838-8","volume":"22","author":"CF Kirkpatrick","year":"2020","unstructured":"Kirkpatrick CF, Liday C, Maki KC. The effects of carbohydrate-restricted dietary patterns and physical activity on body weight and glycemic control. Curr Atheroscler Rep. 2020;22(6):20. https:\/\/doi.org\/10.1007\/s11883-020-00838-8.","journal-title":"Curr Atheroscler Rep"},{"issue":"12","key":"478_CR44","doi-asserted-by":"publisher","DOI":"10.1038\/s41387-017-0006-9","volume":"7","author":"LR Saslow","year":"2017","unstructured":"Saslow LR, Daubenmier JJ, Moskowitz JT, et al. Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes. Nutr Diabetes. 2017;7(12):304. https:\/\/doi.org\/10.1038\/s41387-017-0006-9.","journal-title":"Nutr Diabetes"},{"issue":"1","key":"478_CR45","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1093\/ajcn\/nqac066","volume":"116","author":"A Jayedi","year":"2022","unstructured":"Jayedi A, Zeraattalab-Motlagh S, Jabbarzadeh B, et al. Dose-dependent effect of carbohydrate restriction for type 2 diabetes management: a systematic review and dose-response meta-analysis of randomized controlled trials. Am J Clin Nutr. 2022;116(1):40\u201356. https:\/\/doi.org\/10.1093\/ajcn\/nqac066.","journal-title":"Am J Clin Nutr"},{"key":"478_CR46","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2023.1287987","volume":"10","author":"S Soltani","year":"2023","unstructured":"Soltani S, Jayedi A, Abdollahi S, Vasmehjani AA, Meshkini F, Shab-Bidar S. Effect of carbohydrate restriction on body weight in overweight and obese adults: a systematic review and dose\u2013response meta-analysis of 110 randomized controlled trials. Front Nutr. 2023;10:1287987. https:\/\/doi.org\/10.3389\/fnut.2023.1287987.","journal-title":"Front Nutr"},{"key":"478_CR47","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2025.1609737","volume":"12","author":"SJ Athinarayanan","year":"2025","unstructured":"Athinarayanan SJ, Roberts CGP, Phinney SD, Weimbs T, Friedman AN, Volek JS. Effects of a continuous remote care intervention including nutritional ketosis on kidney function and inflammation in adults with type 2 diabetes: a post-hoc latent class trajectory analysis. Front Nutr. 2025;12:1609737. https:\/\/doi.org\/10.3389\/fnut.2025.1609737.","journal-title":"Front Nutr"},{"issue":"5","key":"478_CR48","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1016\/j.jacl.2019.08.003","volume":"13","author":"CF Kirkpatrick","year":"2019","unstructured":"Kirkpatrick CF, Bolick JP, Kris-Etherton PM, et al. Review of current evidence and clinical recommendations on the effects of low-carbohydrate and very-low-carbohydrate (including ketogenic) diets for the management of body weight and other cardiometabolic risk factors: a scientific statement from the National Lipid Association Nutrition and Lifestyle Task Force. J Clin Lipidol. 2019;13(5):689-711.e1. https:\/\/doi.org\/10.1016\/j.jacl.2019.08.003.","journal-title":"J Clin Lipidol"},{"issue":"13","key":"478_CR49","doi-asserted-by":"publisher","first-page":"7347","DOI":"10.1073\/pnas.1922344117","volume":"117","author":"PK Luukkonen","year":"2020","unstructured":"Luukkonen PK, Dufour S, Lyu K, et al. Effect of a ketogenic diet on hepatic steatosis and hepatic mitochondrial metabolism in nonalcoholic fatty liver disease. Proc Natl Acad Sci USA. 2020;117(13):7347\u201354. https:\/\/doi.org\/10.1073\/pnas.1922344117.","journal-title":"Proc Natl Acad Sci USA"},{"issue":"21","key":"478_CR50","doi-asserted-by":"publisher","first-page":"2074","DOI":"10.1056\/nejmoa022637","volume":"348","author":"FF Samaha","year":"2003","unstructured":"Samaha FF, Iqbal N, Seshadri P, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med. 2003;348(21):2074\u201381. https:\/\/doi.org\/10.1056\/nejmoa022637.","journal-title":"N Engl J Med"},{"issue":"6","key":"478_CR51","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1016\/j.amjmed.2004.04.009","volume":"117","author":"P Seshadri","year":"2004","unstructured":"Seshadri P, Iqbal N, Stern L, et al. A randomized study comparing the effects of a low-carbohydrate diet and a conventional diet on lipoprotein subfractions and C-reactive protein levels in patients with severe obesity. Am J Med. 2004;117(6):398\u2013405. https:\/\/doi.org\/10.1016\/j.amjmed.2004.04.009.","journal-title":"Am J Med"},{"issue":"Supplement_1","key":"478_CR52","doi-asserted-by":"publisher","first-page":"S89","DOI":"10.2337\/dc26-S005","volume":"49","author":"American Diabetes Association Professional Practice Committee for Diabetes","year":"2026","unstructured":"American Diabetes Association Professional Practice Committee for Diabetes. 5. Facilitating positive health behaviors and well-being to improve health outcomes: standards of care in diabetes\u20142026. Diabetes Care. 2026;49(Supplement_1):S89\u2013131. https:\/\/doi.org\/10.2337\/dc26-S005.","journal-title":"Diabetes Care"},{"key":"478_CR53","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2024.111898","volume":"217","author":"AL McKenzie","year":"2024","unstructured":"McKenzie AL, Athinarayanan SJ, Tieghem MRV, et al. 5-Year effects of a novel continuous remote care model with carbohydrate-restricted nutrition therapy including nutritional ketosis in type 2 diabetes: an extension study. Diabetes Res Clin Pr. 2024;217:111898. https:\/\/doi.org\/10.1016\/j.diabres.2024.111898.","journal-title":"Diabetes Res Clin Pr"},{"key":"478_CR54","doi-asserted-by":"publisher","DOI":"10.1136\/bmjnph-2020-000072","author":"D Unwin","year":"2020","unstructured":"Unwin D, Khalid AA, Unwin J, et al. Insights from a general practice service evaluation supporting a lower carbohydrate diet in patients with type 2 diabetes mellitus and prediabetes: a secondary analysis of routine clinic data including HbA1c, weight and prescribing over 6 years. Bmj Nutr Prev Health. 2020. https:\/\/doi.org\/10.1136\/bmjnph-2020-000072.","journal-title":"Bmj Nutr Prev Health"},{"key":"478_CR55","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2026.07.020","author":"MC Petersen","year":"2026","unstructured":"Petersen MC, Smith GI, Farabi SS, et al. Effect of diet macronutrient content on the cardiometabolic response to weight loss: a randomized clinical trial. Cell Metab. 2026. https:\/\/doi.org\/10.1016\/j.cmet.2026.07.020.","journal-title":"Cell Metab"},{"issue":"20","key":"478_CR56","doi-asserted-by":"publisher","first-page":"1636","DOI":"10.1161\/cir.0000000000001186","volume":"148","author":"CE Ndumele","year":"2023","unstructured":"Ndumele CE, Neeland IJ, Tuttle KR, et al. A synopsis of the evidence for the science and clinical management of cardiovascular\u2013kidney\u2013metabolic (CKM) syndrome: a scientific statement from the American Heart Association. Circulation. 2023;148(20):1636\u201364. https:\/\/doi.org\/10.1161\/cir.0000000000001186.","journal-title":"Circulation"},{"issue":"15","key":"478_CR57","doi-asserted-by":"publisher","DOI":"10.3390\/nu15153368","volume":"15","author":"D Dy\u0144ka","year":"2023","unstructured":"Dy\u0144ka D, Kowalcze K, Charuta A, Paziewska A. The ketogenic diet and cardiovascular diseases. Nutrients. 2023;15(15):3368. https:\/\/doi.org\/10.3390\/nu15153368.","journal-title":"Nutrients"},{"key":"478_CR58","doi-asserted-by":"publisher","DOI":"10.1111\/dom.71086","author":"SJ Athinarayanan","year":"2026","unstructured":"Athinarayanan SJ, Bjornstad P, Shanmugam PV, et al. Effectiveness of telehealth low-carbohydrate intervention in preventing chronic kidney disease: a real-world, retrospective, matched cohort study. Diabetes Obes Metab. 2026. https:\/\/doi.org\/10.1111\/dom.71086.","journal-title":"Diabetes Obes Metab"},{"issue":"3","key":"478_CR59","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1097\/HEP.0000000000001713","volume":"84","author":"SJ Athinarayanan","year":"2026","unstructured":"Athinarayanan SJ, Wolfberg AJ, Shanmugam PV, Hameed BA, Bonacini M. Reduced risk of liver-related events among patients receiving individualized nutrition-focused remote care in the United States. Hepatology. 2026;84(3):870\u201385. https:\/\/doi.org\/10.1097\/HEP.0000000000001713.","journal-title":"Hepatology"},{"issue":"1","key":"478_CR60","doi-asserted-by":"publisher","DOI":"10.1016\/j.bj.2023.100677","volume":"47","author":"H Neudorf","year":"2024","unstructured":"Neudorf H, Little JP. Impact of fasting & ketogenic interventions on the NLRP3 inflammasome: a narrative review. Biomed J. 2024;47(1):100677. https:\/\/doi.org\/10.1016\/j.bj.2023.100677.","journal-title":"Biomed J"},{"issue":"2","key":"478_CR61","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1080\/07435800.2026.2659579","volume":"51","author":"SJ Athinarayanan","year":"2026","unstructured":"Athinarayanan SJ, Phinney SD, Adams RN, et al. Broad-spectrum effects of carbohydrate reduction on inflammatory and immune mediators in type 2 diabetes. Endocr Res. 2026;51(2):100\u201316. https:\/\/doi.org\/10.1080\/07435800.2026.2659579.","journal-title":"Endocr Res"},{"issue":"12","key":"478_CR62","doi-asserted-by":"publisher","first-page":"584","DOI":"10.4239\/wjd.v11.i12.584","volume":"11","author":"S Nasser","year":"2020","unstructured":"Nasser S, Vialichka V, Biesiekierska M, Balcerczyk A, Pirola L. Effects of ketogenic diet and ketone bodies on the cardiovascular system: concentration matters. World J Diabetes. 2020;11(12):584\u201395. https:\/\/doi.org\/10.4239\/wjd.v11.i12.584.","journal-title":"World J Diabetes"},{"issue":"1","key":"478_CR63","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1146\/annurev-nutr-071816-064916","volume":"37","author":"JC Newman","year":"2017","unstructured":"Newman JC, Verdin E. \u03b2-Hydroxybutyrate: a signaling metabolite. Annu Rev Nutr. 2017;37(1):51\u201376. https:\/\/doi.org\/10.1146\/annurev-nutr-071816-064916.","journal-title":"Annu Rev Nutr"},{"key":"478_CR64","doi-asserted-by":"publisher","first-page":"237","DOI":"10.2147\/vhrm.s379874","volume":"19","author":"A Diab","year":"2023","unstructured":"Diab A, Dastmalchi LN, Gulati M, Michos ED. A heart-healthy diet for cardiovascular disease prevention: where are we now? Vasc Heal Risk Manag. 2023;19:237\u201353. https:\/\/doi.org\/10.2147\/vhrm.s379874.","journal-title":"Vasc Heal Risk Manag"},{"key":"478_CR65","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.atherosclerosis.2019.11.021","volume":"292","author":"B O\u2019Neill","year":"2020","unstructured":"O\u2019Neill B, Raggi P. The ketogenic diet: pros and cons. Atherosclerosis. 2020;292:119\u201326. https:\/\/doi.org\/10.1016\/j.atherosclerosis.2019.11.021.","journal-title":"Atherosclerosis"},{"issue":"3","key":"478_CR66","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1017\/s0007114515004699","volume":"115","author":"N Mansoor","year":"2016","unstructured":"Mansoor N, Vinknes KJ, Veier\u00f8d MB, Retterst\u00f8l K. Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials. Br J Nutr. 2016;115(3):466\u201379. https:\/\/doi.org\/10.1017\/s0007114515004699.","journal-title":"Br J Nutr"},{"key":"478_CR67","doi-asserted-by":"publisher","first-page":"2246","DOI":"10.1016\/j.clnu.2017.11.001","volume":"37","author":"N Heussinger","year":"2018","unstructured":"Heussinger N, Marina AD, Beyerlein A, et al. 10 patients, 10 years\u2014long term follow-up of cardiovascular risk factors in Glut1 deficiency treated with ketogenic diet therapies: a prospective, multicenter case series. Clin Nutr. 2018;37:2246\u201351. https:\/\/doi.org\/10.1016\/j.clnu.2017.11.001.","journal-title":"Clin Nutr"},{"key":"478_CR68","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-018-0698-8","author":"NH Bhanpuri","year":"2018","unstructured":"Bhanpuri NH, Hallberg SJ, Williams PT, et al. Cardiovascular disease risk factor responses to a type 2 diabetes care model including nutritional ketosis induced by sustained carbohydrate restriction at 1 year: an open-label, non-randomized, controlled study. Cardiovasc Diabetol. 2018. https:\/\/doi.org\/10.1186\/s12933-018-0698-8.","journal-title":"Cardiovasc Diabetol"},{"issue":"5","key":"478_CR69","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/j.plipres.2008.02.003","volume":"47","author":"JS Volek","year":"2008","unstructured":"Volek JS, Fernandez ML, Feinman RD, Phinney SD. Dietary carbohydrate restriction induces a unique metabolic state positively affecting atherogenic dyslipidemia, fatty acid partitioning, and metabolic syndrome. Prog Lipid Res. 2008;47(5):307\u201318. https:\/\/doi.org\/10.1016\/j.plipres.2008.02.003.","journal-title":"Prog Lipid Res"},{"issue":"7","key":"478_CR70","doi-asserted-by":"publisher","first-page":"1225","DOI":"10.1016\/j.jacc.2005.07.006","volume":"46","author":"P Libby","year":"2005","unstructured":"Libby P. The forgotten majority unfinished business in cardiovascular risk reduction. J Am Coll Cardiol. 2005;46(7):1225\u20138. https:\/\/doi.org\/10.1016\/j.jacc.2005.07.006.","journal-title":"J Am Coll Cardiol"},{"issue":"9","key":"478_CR71","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.119.011955","volume":"8","author":"S Zhang","year":"2019","unstructured":"Zhang S, Zhuang X, Lin X, et al. Low-carbohydrate diets and risk of incident atrial fibrillation: a prospective cohort study. J Am Heart Assoc. 2019;8(9):e011955. https:\/\/doi.org\/10.1161\/jaha.119.011955.","journal-title":"J Am Heart Assoc"},{"issue":"12","key":"478_CR72","doi-asserted-by":"publisher","first-page":"2328","DOI":"10.1212\/wnl.54.12.2328","volume":"54","author":"TH Best","year":"2000","unstructured":"Best TH, Franz DN, Gilbert DL, Nelson DP, Epstein MR. Cardiac complications in pediatric patients on the ketogenic diet. Neurology. 2000;54(12):2328\u201330. https:\/\/doi.org\/10.1212\/wnl.54.12.2328.","journal-title":"Neurology"},{"issue":"6","key":"478_CR73","doi-asserted-by":"publisher","first-page":"1401","DOI":"10.1161\/01.cir.60.6.1401","volume":"60","author":"JM Isner","year":"1979","unstructured":"Isner JM, Sours HE, Paris AL, Ferrans VJ, Roberts WC. Sudden, unexpected death in avid dieters using the liquid-protein-modified-fast diet. Observations in 17 patients and the role of the prolonged QT interval. Circulation. 1979;60(6):1401\u201312. https:\/\/doi.org\/10.1161\/01.cir.60.6.1401.","journal-title":"Circulation"},{"issue":"6","key":"478_CR74","doi-asserted-by":"publisher","first-page":"454","DOI":"10.5847\/wjem.j.1920-8642.2023.104","volume":"14","author":"DdeA Fernandes","year":"2023","unstructured":"Fernandes DdeA, Cam\u00f5es GdeF, Ferreira D, et al. Prevalence and risk factors for acquired long QT syndrome in the emergency department: a retrospective observational study. World J Emerg Med. 2023;14(6):454. https:\/\/doi.org\/10.5847\/wjem.j.1920-8642.2023.104.","journal-title":"World J Emerg Med"}],"container-title":["Cardiology and Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40119-026-00478-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40119-026-00478-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40119-026-00478-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:02:23Z","timestamp":1791072143000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s40119-026-00478-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,2]]},"references-count":74,"alternative-id":["478"],"URL":"https:\/\/doi.org\/10.1007\/s40119-026-00478-0","relation":{},"ISSN":["2193-8261","2193-6544"],"issn-type":[{"value":"2193-8261","type":"print"},{"value":"2193-6544","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,2]]},"assertion":[{"value":"24 July 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Caroline G.P. Roberts, Priya V. Shanmugam, Shaminie J. Athinarayanan, and Adam J. Wolfberg are employees of Virta Health and have been granted stock options. Francisco Lopez-Jimenez and Stephen Raskin received no compensation for their contributions. All authors declare that they have no competing interests.","order":1,"name":"Ethics","label":"Conflict of Interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was deemed exempt from institutional review board oversight because it utilized only retrospective, de-identified data, and did not involve any direct interaction or intervention with human participants. The Virta investigators had licensed authorization from Komodo Health to access and analyze the data, and did not receive information that could identify individuals.","order":2,"name":"Ethics","label":"Ethics\/Ethical Approval","group":{"name":"EthicsHeading","label":"Declarations"}}]}}