Evidence map›Paper›PMID 40116814›Full record

ArticleEuropean journal of preventive cardiology2026

Integrating ketone bodies in multi-marker risk prediction of incident heart failure in the multi-ethnic study of atherosclerosis.

Parag Anilkumar Chevli, Senthil Selvaraj, Byron C Jaeger, Aziz Hammoud, Margery A Connelly, Christopher deFilippi, Joao A C Lima, Sadiya S Khan, David M Herrington, Michael D Shapiro and 1 more

Abstract readMulticenter Study
In one paragraph

Article in European journal of preventive cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors.

Parag Anilkumar ChevliDepartment of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.ORCID 0000-0002-4084-8175
Senthil SelvarajDivision of Cardiology, Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, NC, USA.
Byron C JaegerDepartment of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Aziz HammoudDepartment of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.ORCID 0000-0001-9563-7060
Margery A ConnellyLabcorp, Morrisville, NC, USA.ORCID 0000-0002-3917-592X
Christopher deFilippiInova Heart and Vascular Institute, Falls Church, VA, USA.ORCID 0000-0002-0660-4943
Joao A C LimaDivision of Cardiology, Departments of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Sadiya S KhanDivision of Cardiology, Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
David M HerringtonDepartment of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Michael D ShapiroCenter for the Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.ORCID 0000-0002-9071-3287
Muthiah VaduganathanDivision of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.ORCID 0000-0003-0885-1953

Funding

Institute for Clinical and Translational ResearchUL1TR001079 · NCATS · JOHNS HOPKINS UNIVERSITY · PI FORD, DANIEL ERNEST · 2013 to 2017
$60.1M
Wake Forest Clinical and Translational Science AwardUL1TR001420 · NCATS · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI ARD, JAMY D, FOLEY, KRISTIE L · 2015 to 2023
$32.3M
Clinical and Translational Science AwardUL1TR000040 · NCATS · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI GINSBERG, HENRY N · 2012 to 2015
$26.2M
Task Area A Core Study Operations.Task Area A shall encompass annual follow-up of cohort members, clinical endpoints ascertainment, study coordination activities, maintenance of the database and biosp75N92020D00001 · NHLBI · UNIVERSITY OF WASHINGTON · PI MCCLELLAND, ROBYN LEAGH · 2020 to 2025
$17.2M
Task Area A shall encompass annual follow-up of cohort members, clinical events investigations, study operations, and data analysis and manuscript writing. If implemented, Task A.1 will provide fundin75N92020D00005 · NHLBI · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI WATSON, KAROL E · 2020 to 2025
$5.1M
TO EXERCISE OPTION PERIOD ONE (1) FOR TASK AREA A - MESA CORE OPERATIONS, FIELD CENTER.75N92020D00004 · NHLBI · NORTHWESTERN UNIVERSITY · PI SIEGEL, JONATHAN H · 2020 to 2025
$4.5M
Task Area A shall encompass annual follow-up of cohort members, clinical events investigations, study operations, and data analysis and manuscript writing. If implemented, Task A.1 will provide fundin75N92020D00006 · NHLBI · UNIVERSITY OF MINNESOTA · PI PANKOW, JAMES S · 2020 to 2025
$4.4M
Task Area A shall encompass annual follow-up of cohort members, clinical events investigations, study operations, and data analysis and manuscript writing. If implemented, Task A.1 will provide fundin75N92020D00003 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI POST, WENDY S · 2020 to 2025
$3.8M
Task Area A shall encompass annual follow-up of cohort members, clinical events investigations, study operations, and data analysis and manuscript writing. If implemented, Task A.1 will provide fundin75N92020D00007 · NHLBI · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI BERTONI, ALAIN GERALD · 2020 to 2025
$3.5M
Task Area A shall encompass annual follow-up of cohort members, clinical events investigations, study operations, and data analysis and manuscript writing. If implemented, Task A.1 will provide fundin75N92020D00002 · NHLBI · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI SHEA, STEVEN J · 2020 to 2025
$3.4M
Dissecting the Ketone Metabolic Axis in Heart Failure with Reduced Ejection FractionK23HL161348 · NHLBI · DUKE UNIVERSITY · PI Senthil Selvaraj · 2022 to 2026
$1.0M
SUBCLINICAL CARDIOVASCULAR DISEASE STUDYN01HC095166 · HC · UNIVERSITY OF VERMONT &ST AGRIC COLLEGE · PI TRACY, RUSSELL P · 1999 to 2001
$758k
MESA N01-HC-95159MESA N01-HC-95160MESA N01-HC-95161MESA N01-HC-95162MESA N01-HC-95163MESA N01-HC-95164MESA N01-HC-95165MESA N01-HC-95166MESA N01-HC-95167MESA N01-HC-95168MESA N01-HC-95169NCATS NIH HHS UL1 TR000040NCATS NIH HHS UL1 TR001079NCATS NIH HHS UL1 TR001420NHLBI NIH HHS 75N92020D00001NHLBI NIH HHS 75N92020D00002NHLBI NIH HHS 75N92020D00003NHLBI NIH HHS 75N92020D00004NHLBI NIH HHS 75N92020D00005NHLBI NIH HHS 75N92020D00006NHLBI NIH HHS 75N92020D00007NHLBI NIH HHS HHSN268201500003CNHLBI NIH HHS HHSN268201500003INHLBI NIH HHS K23 HL161348NHLBI NIH HHS N01 HC095159NHLBI NIH HHS N01 HC095160NHLBI NIH HHS N01 HC095161NHLBI NIH HHS N01 HC095162NHLBI NIH HHS N01 HC095163NHLBI NIH HHS N01 HC095164NHLBI NIH HHS N01 HC095165NHLBI NIH HHS N01 HC095166NHLBI NIH HHS N01 HC095167NHLBI NIH HHS N01 HC095168NHLBI NIH HHS N01 HC095169NHLBI NIH HHS R03 HL180898NHLBI NIH HHS UL1-TR-000040NHLBI NIH HHS UL1-TR-001079NHLBI NIH HHS UL1-TR-001420
6 · The paper itself

Abstract

aimsCirculating ketone bodies (KB) have emerged as a potential adjunctive biomarker for incident heart failure (HF) risk and might provide incremental information beyond established biomarkers. A multi-marker risk score may improve risk stratification of incident HF in the community. The authors aim to develop a risk score using N-terminal proB-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin (hs-cTnT) and a unique systemic biomarker of KB to predict HF among participants without cardiovascular disease. METHODS AND

resultsA multi-marker score was developed incorporating NT-proBNP ≥ 125 pg/mL, hs-cTnT ≥ 14 ng/L, and total KB ≥ 75th percentile (316 μmol/L), with one point allocated for each abnormal marker among Multi-Ethnic Study of Atherosclerosis participants. Multivariable Cox model was used to assess the association between multi-marker risk score and the risk of incident HF. Among 6748 participants, there were 383 incident HF events over a median follow-up of 15.7 years. The three biomarkers exhibited poor correlation with one another (r < 0.06 for all). The addition of KB to NT-proBNP and hs-cTnT to identify incident HF improved 5- and 10-year risk prediction (C-statistic 0.74 vs. 0.77, P = 0.02 and 0.70 vs. 0.73, P = 0.02, respectively). There was no evidence of miscalibration using the multi-marker score for predicting 5- and 10-year HF risk (P > 0.05). A graded association was observed between the multi-marker score and risk of HF independent of established clinical factors.

conclusionThe addition of plasma KB to a clinical risk score using biomarkers of cardiac injury and stress may further improve the prediction of incident HF.

Indexed as

AtherosclerosisHeart FailurePeptide FragmentsTroponin TAgedBiomarkersFemaleHumansIncidenceMaleMiddle AgedNatriuretic Peptide, BrainPredictive Value of TestsPrognosisProspective StudiesRisk AssessmentBiomarkersNatriuretic Peptide, BrainPeptide Fragmentspro-brain natriuretic peptide (1-76)Troponin TCardiovascular diseaseHeart failureKetone bodiesRisk prediction

Identifiers

PMID40116814
PMCPMC12550829

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.