ArticleESC heart failure2026
Ketone bodies and incident heart failure: 20-year results from the prospective British Regional Heart Study.
Article in ESC heart failure, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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.
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.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
Abstract
introductionKetone bodies (KBs), acetoacetate, and β-hydroxybutyrate, are an important fat-derived alternative energy source for the heart and have been implicated in the pathogenesis of cardiovascular disease. The study aimed to determine the relationship between total KB (acetoacetate + β-hydroxybutyrate) and KB ratio (acetoacetate:β-hydroxybutyrate) with incident heart failure (HF) in older men.
methodsThree thousand four hundred fifty-nine men without prevalent myocardial infarction or HF from the prospective cohort British Regional Heart Study were included in the analysis. Ketone body levels were measured by nuclear magnetic resonance spectroscopy. Participants were followed up for a median 15.9 years.
resultsThree hundred seventy-five men developed HF. Total KB was not significantly associated with incident HF {age-adjusted standardized hazard ratios [HRs] [95% confidence interval (CI)] 0.94 [0.84-1.04], P = .231 for trend}. However, KB ratio was significantly associated with incident HF (age-adjusted standardized HR (95% CI) 1.12 [1.01-1.24], P = .023 for trend). Risk tended to increase with increasing levels of KB ratio from 0.35 with risk significantly raised when the KB ratio was above 0.55 (top decile) even after adjustment for traditional cardiovascular risk factors, inflammatory markers, and NT-pro-BNP [HR (95% CI) for KB ratio >0.55 vs <0.18 (bottom quartile) = 1.60 (1.13-2.27), P = .008]. The increased risk associated with elevated KB ratio was more evident in the younger men (age <70 years). When examined by levels of NT-pro-BNP, elevated KB ratio was significantly associated with increased HF risk only in the presence of elevated NT-pro-BNP (>83 pg/ml; above the median) [age-adjusted HR = 1.87 (1.25-2.81)]. Weaker associations were seen in those without raised NT-pro-BNP [HR = 1.23 (0.66-2.27)].
conclusionElevated KB ratio is associated with a significantly increased risk of HF and may serve as a biomarker of HF incidence particularly when NT-pro-BNP is also elevated.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.