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Arrhythmias & electrophysiologyCohort study

Circulating ketone bodies and risk of incident atrial fibrillation: insights from the Multi-Ethnic Study of Atherosclerosis (MESA) and UK Biobank cohorts

Eur J Prev CardiolPublished

  • Prospective cohort study
  • multicentre
  • multivariable-adjusted Cox models
  • prespecified interaction analyses
Read the original article ↗

Authors' conclusion

Higher concentrations of KB are associated with an increased risk of AF in predominantly healthy, community-based cohorts, acknowledging that many participants also had comorbidities such as hypertension and diabetes, particularly among smokers.

Study context

Population
Participants without baseline atrial fibrillation (AF) in the MESA and UK Biobank cohorts
Participants
6,783 vs 116,480
Exposure
Per doubling of circulating total ketone bodies
  • MESAn = 6,783
  • UK Biobank (UKB)n = 116,480
Outcome
Incident AF
Follow-up
Median 16.5 (10.3-17.4) years in MESA and 13.6 (12.8-14.4) years in the UKB

Main finding

Incident AF per doubling of total KB (MESA)

Hazard ratio

1.08

95% CI 1.00–1.16

Per doubling of total KB
HR 1.08 (95% CI 1.00–1.16)

Per doubling of total KB, as printed

As reported in the abstract

Observational data: associations, not effects.

Further findings

OutcomeHR (95% CI)
Incident AF per doubling of total KB, by smoking status (subgroup) — Per doubling of total KB · current smokers · significant interaction with current smoking1.32 (1.08–1.61)
Incident AF per doubling of total KB, by smoking status (subgroup) — Per doubling of total KB · former/never smokers · significant interaction with current smoking1.05 (0.95–1.13)

Incident AF by ketone bodies (KB) type (β-hydroxybutyrate, acetoacetate, acetone)

Consistent results across KB types

Original publication

Circulating ketone bodies and risk of incident atrial fibrillation: insights from the MESA and UK Biobank cohorts. Eur J Prev Cardiol. Published 24 September 2025. doi:10.1093/eurjpc/zwaf543
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Summarised from the published abstract; every number is checked against it