Fasting ketonuria is inversely associated with coronary artery calcification in non-diabetic individuals
Fasting ketonuria is inversely associated with coronary artery calcification in non-diabetic individuals
Background
and aims
Increased levels of ketone bodies, an alternative fuel when
glucose availability is low, may exert beneficial effects on cardiovascular
disease (CVD) risk factors. Whether increased ketone bodies are associated
with coronary artery calcium (CAC), a
recognized and strong cardiovascular risk factor, remains unknown. We
investigated the association of fasting ketonuria with CAC and its progression.
Methods
Cross-sectional and longitudinal studies were
conducted in adults without diabetes or CVD. Subjects underwent routine health
examinations including cardiac computed tomography estimations
of CAC scores. Logistic regression models were performed
to compute the odds ratios (ORs), 95% confidence intervals (CIs), for prevalent
CAC scores >0 according to fasting ketonuria categories (0, 1, and ≥2).
Linear mixed models with random intercepts and random slopes were used to
estimate CAC progression.
Results
Of 144,346 subjects, 12.3% had CAC scores
>0 at baseline. Overall, higher fasting ketonuria was associated with
decreased prevalence of coronary calcification than no ketonuria.
Multivariable-adjusted ORs (95% CIs) for prevalent CAC by comparing ketonuria
categories 1 and ≥2 with no ketonuria, were 0.94 (0.84–1.06) and 0.82
(0.71–0.95), respectively. The associations did not differ according to
clinically relevant subgroups. Ketonuria was associated with lower CAC
progression over time; the multivariable adjusted ratio of progression rates
comparing ketonuria ≥2 versus no ketonuria was 0.976
(0.965–0.995).
Conclusions
We found an inverse association between fasting
ketonuria and subclinical coronary atherosclerosis, in both prevalence
and progression. The potentially protective role of increased ketone body formation
in CVD requires further investigation.
Atherosclerosis, Coronary artery calcium, Coronary artery disease, Ketone bodies, Ketosis
1 - 7
Cho, In Young
675a50d7-5b74-4afc-8b09-eed036ac0b7b
Chang, Yoosoo
cb926bfb-b138-4b67-9345-30868bfdb9b0
Sung, Eunju
b216088e-cd42-4b3d-bd6f-1bf6b3078870
Kim, Yejin
6c3ae3de-e235-437c-a18e-1330d2a1c2ac
Kang, Jae-Heon
8a0c9031-2405-4d88-9b24-722efe5493b8
Shin, Hocheol
805b1fc9-ad00-477b-839e-f3dc7273f727
Wild, Sarah H.
fccd6b84-96a8-41b0-ac9a-50d894515d37
Byrne, Christopher
1370b997-cead-4229-83a7-53301ed2a43c
Ryu, Seungho
b17b879c-174c-4bb0-83d1-6116d4649347
May 2022
Cho, In Young
675a50d7-5b74-4afc-8b09-eed036ac0b7b
Chang, Yoosoo
cb926bfb-b138-4b67-9345-30868bfdb9b0
Sung, Eunju
b216088e-cd42-4b3d-bd6f-1bf6b3078870
Kim, Yejin
6c3ae3de-e235-437c-a18e-1330d2a1c2ac
Kang, Jae-Heon
8a0c9031-2405-4d88-9b24-722efe5493b8
Shin, Hocheol
805b1fc9-ad00-477b-839e-f3dc7273f727
Wild, Sarah H.
fccd6b84-96a8-41b0-ac9a-50d894515d37
Byrne, Christopher
1370b997-cead-4229-83a7-53301ed2a43c
Ryu, Seungho
b17b879c-174c-4bb0-83d1-6116d4649347
Cho, In Young, Chang, Yoosoo, Sung, Eunju, Kim, Yejin, Kang, Jae-Heon, Shin, Hocheol, Wild, Sarah H., Byrne, Christopher and Ryu, Seungho
(2022)
Fasting ketonuria is inversely associated with coronary artery calcification in non-diabetic individuals.
Atherosclerosis, 348, .
(doi:10.1016/j.atherosclerosis.2022.03.018).
Abstract
Background
and aims
Increased levels of ketone bodies, an alternative fuel when
glucose availability is low, may exert beneficial effects on cardiovascular
disease (CVD) risk factors. Whether increased ketone bodies are associated
with coronary artery calcium (CAC), a
recognized and strong cardiovascular risk factor, remains unknown. We
investigated the association of fasting ketonuria with CAC and its progression.
Methods
Cross-sectional and longitudinal studies were
conducted in adults without diabetes or CVD. Subjects underwent routine health
examinations including cardiac computed tomography estimations
of CAC scores. Logistic regression models were performed
to compute the odds ratios (ORs), 95% confidence intervals (CIs), for prevalent
CAC scores >0 according to fasting ketonuria categories (0, 1, and ≥2).
Linear mixed models with random intercepts and random slopes were used to
estimate CAC progression.
Results
Of 144,346 subjects, 12.3% had CAC scores
>0 at baseline. Overall, higher fasting ketonuria was associated with
decreased prevalence of coronary calcification than no ketonuria.
Multivariable-adjusted ORs (95% CIs) for prevalent CAC by comparing ketonuria
categories 1 and ≥2 with no ketonuria, were 0.94 (0.84–1.06) and 0.82
(0.71–0.95), respectively. The associations did not differ according to
clinically relevant subgroups. Ketonuria was associated with lower CAC
progression over time; the multivariable adjusted ratio of progression rates
comparing ketonuria ≥2 versus no ketonuria was 0.976
(0.965–0.995).
Conclusions
We found an inverse association between fasting
ketonuria and subclinical coronary atherosclerosis, in both prevalence
and progression. The potentially protective role of increased ketone body formation
in CVD requires further investigation.
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More information
Accepted/In Press date: 15 March 2022
e-pub ahead of print date: 30 March 2022
Published date: May 2022
Additional Information:
Funding Information:
This work was supported by the SKKU Excellence in Research Award Research Fund, Sungkyunkwan University , 2020. CDB is supported in part by the Southampton NIHR Biomedical Research Centre (IS-BRC-20004), UK .
Keywords:
Atherosclerosis, Coronary artery calcium, Coronary artery disease, Ketone bodies, Ketosis
Identifiers
Local EPrints ID: 456046
URI: http://eprints.soton.ac.uk/id/eprint/456046
ISSN: 0021-9150
PURE UUID: 30a71e61-c4dd-43e0-b38d-9180ae6bb728
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Date deposited: 12 Apr 2022 17:12
Last modified: 17 Mar 2024 07:12
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Contributors
Author:
In Young Cho
Author:
Yoosoo Chang
Author:
Eunju Sung
Author:
Yejin Kim
Author:
Jae-Heon Kang
Author:
Hocheol Shin
Author:
Sarah H. Wild
Author:
Seungho Ryu
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