Highest Rated Papers
Seven Years of 700 Cholesterol Without Coronary Atherosclerosis: A Lean Mass Hyper-Responder Case Report
Nicholas G. Norwitz, David Feldman, Adrian Soto-Mota
Diseases·2026
Background: While reducing LDL cholesterol (LDL-C) remains central focuses of conventional preventive cardiology, substantial heterogeneity exists in the cardiovascular risk associated with even extreme LDL-C elevations, likely depending heavily on the broader metabolic context. Specifically, the lean mass hyper-responder (LMHR) phenotype—characterized by markedly elevated LDL-C with elevated high-density lipoprotein cholesterol (HDL-C) and low triglycerides in the setting of a ketogenic diet—has recently been described, though its long-term risk profile remains poorly defined. Case Presentation: We describe a male in his 30s without any congenital dyslipidemia who adopted a ketogenic diet for the management of ulcerative colitis and who subsequently exhibited a sixfold increase in LDL-C from a baseline of 95 mg/dL to 574 mg/dL, with total cholesterol of up to 705 mg/dL, HDL-C at 124 mg/dL, and triglycerides at 34 mg/dL. Despite maintaining these extreme lipid levels for nearly seven years, he demonstrated no coronary plaque or stenosis on coronary computed tomography angiography (CCTA; CAD-RADS = 0). Additionally, quantification of coronary plaque as assessed by AI-guided quantified analysis by Heartflow® identified 0 mm3 plaque in any vessels, placing him in the lowest percentile for atherosclerotic plaque. Conclusions: This case represents an extreme and extensively characterized example of the LMHR phenotype and highlights the limitations of extrapolating cardiovascular risk from LDL-C levels alone without consideration of broader patient context and the etiology of hypercholesterolemia. While a single case cannot redefine clinical practice, this well-characterized case is consistent with emergent literature on LMHR, and careful study of such individuals may provide valuable insights into lipid metabolism, atherosclerosis biology, and precision cardiovascular risk assessment.
★ 3.0 (1)
View paper →The European Union and the Securitization of Migration
Jef Huysmans
JCMS: Journal of Common Market Studies·2000·715 citations
This article deals with the question of how migration has developed into a security issue in western Europe and how the European integration process is implicated in it. Since the 1980s, the political construction of migration increasingly referred to the destabilizing effects of migration on domestic integration and to the dangers for public order it implied. The spillover of the internal market into a European internal security question mirrors these domestic developments at the European level. The Third Pillar on Justice and Home Affairs, the Schengen Agreements, and the Dublin Convention most visibly indicate that the European integration process is implicated in the development of a restrictive migration policy and the social construction of migration into a security question. However, the political process of connecting migration to criminal and terrorist abuses of the internal market does not take place in isolation. It is related to a wider politicization in which immigrants and asylum‐seekers are portrayed as a challenge to the protection of national identity and welfare provisions. Moreover, supporting the political construction of migration as a security issue impinges on and is embedded in the politics of belonging in western Europe. It is an integral part of the wider technocratic and political process in which professional agencies – such as the police and customs – and political agents – such as social movements and political parties – debate and decide the criteria for legitimate membership of west European societies.
★ 3.0 (1)
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