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Keto diet improves endothelial function with “pleotropic”

role of βOHB –Published in JACC Focus Seminar

Therapeutic Potential of Ketone Bodies for Patients With Cardiovascular Disease:

JACC Focus Seminar

Salva R Yurista 1, Cher-Rin Chong 2, Juan J Badimon 3, Daniel P Kelly 4, Rudolf A de Boer 5, B Daan Westenbrink 6

Affiliations

1 University Medical Center Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands. Electronic address: https://twitter.com/salvareverentia.
2 Basil Hetzel Institute for Translational Research, The Queen Elizabeth Hospital, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia.
3 AtheroThrombosis Research Unit, Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
4 Cardiovascular Institute, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
5 University Medical Center Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands. Electronic address: https://twitter.com/Rudolf_deboer.
6 University Medical Center Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands. Electronic address: b.d.westenbrink@umcg.nl.

Abstract

Metabolic perturbations underlie a variety of cardiovascular disease states; yet, metabolic interventions to prevent or treat these disorders are sparse. Ketones carry a negative clinical stigma as they are involved in diabetic ketoacidosis. However, evidence from both experimental and clinical research has uncovered a protective role for ketones in cardiovascular disease. Although ketones may provide supplemental fuel for the energy-starved heart, their cardiovascular effects appear to extend far beyond cardiac energetics. Indeed, ketone bodies have been shown to influence a variety of cellular processes including gene transcription, inflammation and oxidative stress, endothelial function, cardiac remodeling, and cardiovascular risk factors. This paper reviews the bioenergetic and pleiotropic effects of ketone bodies that could potentially contribute to its cardiovascular benefits based on evidence from animal and human studies.

Keywords: cardiovascular disease; heart failure; ketones; pleiotropic effects.

Different Methods to Induce Nutritional Ketosis

Several ketone supplementation approaches including 1,3-butanediol, medium-chain triglyceride (MCT), ketone salts (KS), and ketone ester (KE) have been explored for their ability to raise circulating ketone levels in various preclinical and clinical scenarios. βOHB = beta-hydroxybutyrate.