Purpose of review Total ceramide levels in cardiac tissue relate to cardiac dysfunction in animal models. However, emerging evidence suggests that the fatty acyl chain length of ceramides also impacts their relationship to cardiac function. This review explores evidence regarding the relationship between ceramides and left ventricular dysfunction and heart failure. It further explores possible mechanisms underlying these relationships. Recent findings In large, community-based cohorts, a higher ratio of specific plasma ceramides, C16?:?0/C24?:?0, related to worse left ventricular dysfunction. Increased left ventricular mass correlated with plasma C16?:?0/C24?:?0, but this relationship became nonsignificant after adjustment for multiple comparisons. Decreased left atrial function and increased left atrial size also related to C16?:?0/C24?:?0. Furthermore, increased incident heart failure, overall cardiovascular disease (CVD) mortality and all-cause mortality were associated with higher C16?:?0/C24?:?0 (or lower C24?:?0/C16?:?0). Finally, a number of possible biological mechanisms are outlined supporting the link between C16?:?0/C24?:?0 ceramides, ceramide signalling and CVD. Summary High cardiac levels of total ceramides are noted in heart failure. In the plasma, C16?:?0/C24?:?0 ceramides may be a valuable biomarker of preclinical left ventricular dysfunction, remodelling, heart failure and mortality. Continued exploration of the mechanisms underlying these profound relationships may help develop specific lipid modulators to combat cardiac dysfunction and heart failure.
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