Cor Vasa 2025, 67(3):402-407 | DOI: 10.33678/cor.2024.104

Ketone Body in Heart Failure Patients with Diabetes: Pathophysiology and the Potential Therapeutic Benefit: a Literature Review

Hanestya Oky Hermawan^a, Primasitha Maharany Harsoyo^a, Faizal Ablansah Anandita^a, Aisya Ayu Shafira^b, Deasy Ardiany^c, Andrianto^a

^a Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University, Surabaya, Indonesia

^b Faculty of Medicine, Airlangga University, Surabaya, Indonesia

^c Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, Indonesia

Background: Common knowledge of heart failure treatment target is to intervene in the renin-angiotensin-aldosterone system and the sympathetic autonomic nervous system. However, metabolic aspect in the therapy of heart failure is rarely discussed. It is worth noting that heart failure often co-exist with diabetes. Thus, there is a need for a treatment that can be beneficial for these two diseases. During the pathophysiological transition to heart failure, metabolic abnormalities may occur, and lactic acid, ketone bodies, and amino acids may be used as alternative energy sources. Ketone body has been shown to be associated with these two diseases. Treatment using ketone body may be beneficial to treat patients with heart failure and diabetes.

Objective: To provide a comprehensive review of preclinical and clinical studies on the therapeutic effects of ketone bodies for heart failure.

Method: This study is literature reviews on online databases using keywords according to the Medical Subject Headings (MeSH). The focused intervention is ketone bodies therapy (sodium-3-OHB) or SGLT2i as ketone inducer. We focused on the result of therapy and any ketosis side effect recorded.

Results: A total of 14 studies (6 human studies and 8 animal studies) related on the therapeutic effects of ketone bodies was selected. A total of 8,742 (8 healthy participants) participants was involved in ketone bodies therapy (sodium-3-OHB) or SGLT2i intervention.

Conclusion: Ketogenic therapy and systemic ketosis regulation show promise based on metabolic changes in the hearts of patients with diabetes and heart failure. This study may provide a literature basis for further research to determine the safety and efficacious limitations of long-term ketone body therapy.

Keywords: Diabetes mellitus, Heart failure, Ketone body, Ketone therapy,

Received: November 12, 2024; Revised: November 12, 2024; Accepted: December 11, 2024; Prepublished online: June 2, 2012; Published: June 20, 2025  Show citation