Retrospective Review of the Safety and Effectiveness of a Low-carbohydrate Ketogenic Diet Intervention in Patients With Overweight or Obesity and Heart Failure

Background: Evidence suggests a therapeutic role for ketones in patients with heart failure (HF).However, the safety and effectiveness of a low-carbohydrate ketogenic diet (LCKD) for weight loss in patients with overweight or obesity and HF remain unknown. Methods and Results:A retrospective review from 2006 to 2024 was conducted of all patients with overweight or obesity and HF who were prescribed an LCKD and followed for at least 1 year in a university-based weight loss clinic specializing in the use of an LCKD to promote weight loss.Using electronic health record data, each patient's metabolic outcomes (including weight, lipid panel, and basic chemistries), echocardiographic measures, and medications were compared before and after use of an LCKD.HF hospitalization, a composite of HF hospitalization or death, and all-cause mortality rates and rate ratios (RR) were calculated.HF hospitalization and the composite of HF hospitalization or death rates were stratified by HF classification, adherence, and degree of weight loss.One hundred twentyfive patients were included: 59 patients with HF with reduced ejection fraction (EF) (mean age 57.3 11.6 years, mean body mass index 43.7 8.1 kg/m 2 ) and 66 patients with HF with preserved EF (mean age 65.3 10.2 years, mean body mass index 46.6 14.2 kg/m 2 ).Over a mean follow-up of 2.0 1.8 years, body weight decreased by a median (interquartile range) of 11.2 kg (-19.5, -4.4; P < 0.01).There were no significant changes observed in left ventricular EF.The rate of HF hospitalization following an LCKD intervention decreased significantly overall (RR 0.5, 95% CI 0.40.9)and among patients with HF with preserved EF (RR 0.5, 95% CI 0.30.9),with a numerical reduction in HF hospitalization among patients with HF with reduced EF (RR 0.6, 95% CI 0.31.1).No significant differences were observed in the composite outcome of HF hospitalization or death.Conclusions: An LCKD among patients with overweight or obesity and HF appears to be safe and effective for weight loss, with potential additional benefits for improving certain metabolic markers and the rate of HF hospitalization.(