Heart failure & cardiomyopathiesCohort study
Ketone bodies and incident heart failure: 20-year results from the prospective British Regional Heart Study
- prospective cohort
Authors' conclusion
Elevated 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.
Study context
- Population
- Older men without prevalent myocardial infarction or heart failure (HF) from the British Regional Heart Studymen included in the analysis, median follow-up 15.9 years
- Participants
- Three thousand four hundred fifty-nine men
- Exposure
- Total KB and KB ratio with incident heart failure
Main finding
As reported in the abstract
Incident HF · median 15.9 years
Men who developed HF
Three hundred seventy-five
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Incident HF, KB ratio >0.55 vs <0.18 | 1.60 (1.13–2.27) | P = 0.008 | |
| 0.512Hazard ratio (log scale) |
- Incident HF, KB ratio >0.55 vs <0.18: adjusted for traditional cardiovascular risk factors, inflammatory markers, and NT-pro-BNP
Incident HF by total KB
- age-adjusted standardized HR (95% CI) per standardized increase in total KB
- 0.94 [0.84-1.04]
- P = .231 for trend
- not significantly associated
Incident HF by KB ratio
- age-adjusted standardized HR (95% CI) per standardized increase in KB ratio
- 1.12 [1.01-1.24]
- P = .023 for trend
Incident HF, KB ratio >0.55 vs <0.18
- Risk tended to increase with increasing levels of KB ratio from 0.35
Incident HF by KB ratio, by age (subgroup)
- Increased risk associated with elevated KB ratio more evident in younger men (age <70 years)
Incident HF by elevated KB ratio, by NT-pro-BNP (subgroup)
- Elevated NT-pro-BNP (>83 pg/ml; above the median), age-adjusted HR
- 1.87 (1.25-2.81)
- Without raised NT-pro-BNP, HR
- 1.23 (0.66-2.27)
Original publication
Ketone bodies and incident heart failure: 20-year results from the prospective British Regional Heart Study. ESC Heart Fail. Published 14 January 2026. doi:10.1093/eschf/xvag015
Summarised from the published abstract; every number is checked against it