Table 1.

Therapeutic and dietary strategies to enhance the delivery of ketone bodies (KB) to the heart.

Intravenous infusion of KB raises circulating KB levels along with their ensuing supply to the heart

Ketone esters can be given orally whereby they are cleaved into ketone bodies in the gastro-intestinal tract and released into the circulation by the liver, increasing ketone body supply to the heart

The ketogenic diet (high-fat/low-carbohydrate diet) increases the supply of fatty acids to the liver with an attendant enhanced ketogenesis in the liver raising circulating fatty acid levels and their supply to the heart

Sodium-glucose co-transporter-2 (SGLT2) inhibitors increase glucose excretion in the urine and produce a fasting-like state with a resultant increase in lipolysis in the adipose tissue and delivery of fatty acids to the liver

Similar to a ketogenic diet, SGLT2 inhibitors increase ketogenesis in the liver, raising circulating ketone levels and ketone delivery and supply to the heart