Therapeutic potential of ketone bodies on exercise intolerance in heart failure: looking beyond the heart

This review examines the therapeutic potential of ketone bodies for exercise intolerance in heart failure. It notes that ketone monoesters are de-esterified into two beta-hydroxybutyrate molecules and are being used in multiple clinical trials in heart failure patients. The authors focus on non-cardiac effects, arguing that vascular and skeletal muscle dysfunction are heavily implicated in reduced exercise tolerance in heart failure with reduced and preserved ejection fraction. They review evidence on how ketone therapy may improve cardiovascular and skeletal muscle function and identify potential mechanisms.