Ketogenic diets have been found to be effective medical interventions for treating metabolic and mental disorders. Nonetheless, concerns remain regarding their safety, specifically in regard to their potential for increased cardiac risk, despite the fact that available data does not prove such risk. Much of the misperception has to do with nutritional bias, the improper interpretation of studies and a misunderstanding of what encompasses cardiac risk. When correcting this misperception, the published data demonstrates a neutral or beneficial impact on cardiac risk for the majority of people who follow a ketogenic diet. This discussion will explore these topics in addition to acknowledging that there is a small subset of individuals, so-called “lean mass hyper responders” who experience a dramatic rise in LDL cholesterol when following a ketogenic diet, who should have their future cardiac risk assessed separately given emerging evidence on the horizon.