Circulating ketone bodies as signals for cardiovascular disease and mortality.

Underlying mechanisms and potential benefits of increased circulating ketone bodies in heart failure. Heart failure is associated with an increase in catecholamines, pro-inflammatory cytokines, and natriuretic peptides, resulting in a decrease in ketone body clearance and an increase in ketogenesis. The consequent elevation in circulating ketone bodies results in an increased cardiac ketone body oxidation. This latter effect is further escalated after ketone body or SGLT2 inhibitor treatment, resulting in potential cardiac benefits in heart failure. Abbreviations: KB, ketone body; SGLT2, sodium–glucose co-transporter 2.