The role of point-of-care 3-hydroxybutyrate testing in patients with type 2 diabetes undergoing coronary angiography

Abstract

PurposeKetone bodies, 3-hydroxybutyrate (3BOHB), and acetoacetate derive from increased free fatty acid beta-oxidation, thus reflecting marked insulin deprivation with or without decompensated diabetes. Objectives of this study were (1) to determine circulating levels of 3BOHB in patients with and without type 2 diabetes (T2DM), before and after an elective coronary angiography; (2) to detect 3BOHB modification during the procedure; (3) to study possible associations between 3BOHB and clinical parameters/outcomes.MethodsSixteen T2DM (72 ± 11 years) and 22 matched controls (71 ± 12 years) undergoing elective coronary angiography were enrolled. In all subjects, biohumoral parameters were determined at hospital admission. Point-of-care determinations of 3BOHB, glucose, and creatinine were performed, at 7 a.m, immediately before and after the procedure. The duration of the fasting period and of the procedure was recorded.ResultsT2DM had significantly higher fasting (0.538 ± 0.320 vs 0.255 ± 0.197 mM/l; p = 0.005) and pre-procedural (0.725 ± 0.429 vs 0.314 ± 0.205; p = 0.002) 3BOHB concentrations than controls. Similarly, absolute increment of 3BOHB from the morning value was significantly greater in T2DM (0.369 ± 0.252 vs 0.127 ± 0.135 in controls; p = 0.002). Significant correlations were observed between pre-procedure 3BOHB and glucose levels (r = 0.586; p < 0.0001) and between pre-procedure 3BOHB and fasting creatinine concentrations (r = 0.364; p = 0.029).ConclusionsAn overnight fasting period and a concomitantly stressful condition induce inappropriate 3BOHB increase in T2DM. Point-of-care capillary 3BOHB may be useful before any procedural/surgical intervention in these patients.

Association of Serum β-Hydroxybutyrate and Coronary Artery Disease in an Urban Chinese Population

“…Hence, the increased metabolism of ketones may play a part in the response to myocardial ischemia ( 21 ). Accumulating evidence has shown that the BHB level is increased in patients with heart failure ( 14 , 22 ), obese and/or T2DM ( 12 , 23 ). Of importance, with metabolic dysfunction as an inherent feature of the CAD pathophysiology, whether circulating BHB is increased in CAD remains poorly understood.…”

“…During perturbed tissue metabolism, an increase in BHB may help circumvent the metabolic malfunctions that directly contribute to disease pathophysiology ( 11 ). Recent studies have shown that BHB level was increased in a myriad of pathological conditions, such as type 2 diabetes mellitus (T2DM) ( 12 ), arrhythmogenic cardiomyopathy ( 13 ), and heart failure ( 14 ). In addition, it was reported that BHB was increased in patients with non-ST segment elevation acute coronary syndrome, which reflects the oxidative stress and hypoxic state that myocardial cells suffer.…”

Association of Serum β-Hydroxybutyrate and Coronary Artery Disease in an Urban Chinese Population

“…The most robust evidence from a retrospective cohort study demonstrated that β-HDBA was independently and signi cantly associated with adverse cardiovascular events and therefore could serve as a novel biomarker predicting both survival and incidents of cardiovascular events in patients with hemodialysis [16]. Accumulating evidence has also shown that β-HDBA levels were elevated in patients with heart failure [14,21], obese and/or type 2 diabetes [12,22]. Of importance, with metabolic dysfunction as an inherent feature of the CAD pathophysiology, whether circulating β-HDBA is increased in CAD remains poorly understood.…”

“…When perturbed tissue metabolism happens, an increase in β-HDBA (ketone bodies) may help circumvent the metabolic malfunctions that directly contributes to disease pathophysiology [11]. Recent studies have showed that β-HDBA level was increased in a myriad of pathological conditions, including type 2 diabetes [12], arrhythmogenic cardiomyopathy [13] and heart failure [14]. In addition, it was reported that β-HDBA was elevated in non-ST segment elevation acute coronary syndrome patients, re ecting the oxidative stress and the hypoxic state that suffers the myocardial cells, which indicated that β-HDBA may have a great potential for early diagnosis of acute coronary syndrome [15].…”

Ultra-performance liquid chromatography-mass spectrometry-based metabolomics reveals Huangqiliuyi decoction attenuates abnormal metabolism as a novel therapeutic opportunity for type 2 diabetes

“…The abnormal increase in the content of 3-hydroxybutyrate in the model group may be the result of the lack of insulin in the diabetic rats, which led to the compensatory increase to supply the energy required for physiological activities in the body. 102 …”