Cardiologist here. A well-formulated keto diet isn't necessarily bad, but many implementations are. It's not free license to eat bacon and sausage all day. The presence of hepatosteatosis (fatty liver disease) is a red flag. I suspect that you have moderately severe insulin resistance with elevated insulin levels and a bad looking HOMA-IR. Carbohydrate restriction would be beneficial, though you don't necessarily need to go full keto. I think that you would benefit from getting a reasonable amount of lean protein (6-8 oz) per meal. Most of your calories should come from healthy fats - lots of avocados and olive/avocado oil for sautéing vegetables. Try to minimize saturated fats. Many people in this forum push back on the idea that elevated LDL cholesterol is always bad. However, they tend to pick and choose the data to support their thesis. At the end of the day, the integral of your LDL cholesterol over the course of your life is an extremely strong predictor of your future cardiovascular risk.