{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T11:17:35Z","timestamp":1769080655468,"version":"3.49.0"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":447,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2024,7,25]],"date-time":"2024-07-25T00:00:00Z","timestamp":1721865600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Seoul National University 2021 Research Fund","award":[": 800-20210528"],"award-info":[{"award-number":[": 800-20210528"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>An association between obesity, metabolic abnormalities and clinical hypertrophic cardiomyopathy (HCM) expression has been reported. We investigated whether managing dyslipidaemia with fibrates could affect the clinical expression of HCM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We screened patients who used fibrates between 2010 and 2017 from a nationwide database. After excluding patients with a history of HCM, we identified fibrate-user group (n = 412 823). We then constructed a 1:1 matched cohort of fibrate-na\u00efve participants (n = 412 823). After a 1 year lag period, we identified the incident HCM cases for the following 5 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During a median follow-up period of 3.96 years, we identified 454 incident clinical HCM cases. After adjusting for covariates, fibrate use was associated with a lower risk of clinical HCM expression [hazard ratio (HR) 95% confidence interval (CI): 0.763 (0.630\u20130.924)]. In subgroup analyses, fibrate use was associated with a reduced risk of clinical HCM expression in patients with a body mass index \u226525 kg\/m2 and those with abdominal obesity [HR (95% CI): 0.719 (0.553\u20130.934) and 0.655 (0.492\u20130.872)], but not in those without obesity. Fibrate use was also associated with lower risks of incident clinical HCM in patients with triglyceride levels \u2265150 mg\/dL and those with metabolic syndrome [HR (95% CI): 0.741 (0.591\u20130.929) and 0.750 (0.609\u20130.923)], but not in their counterparts. Regarding lifestyle behaviours, fibrate use appeared to provide more prognostic benefits in patients who currently smoked, consumed alcohol or did not engage in regular physical activities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The use of fibrates is associated with a lower incidence of clinical HCM expression. This association was also more prominent in those with obesity, unhealthy metabolic profiles and poor lifestyle behaviours.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.15004","type":"journal-article","created":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T02:25:10Z","timestamp":1721960710000},"page":"3972-3981","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Association of Fibrate Use with Clinical Expression of Hypertrophic Cardiomyopathy"],"prefix":"10.1093","volume":"11","author":[{"given":"Chan Soon","family":"Park","sequence":"first","affiliation":[{"name":"Cardiovascular Center, Seoul National University Hospital , Seoul ,","place":["Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bongseong","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Statistics and Actuarial Science, Soongsil University , Seoul ,","place":["Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin-Hyung","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Statistics and Actuarial Science, Soongsil University , Seoul ,","place":["Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tae-Min","family":"Rhee","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Seoul National University Hospital Healthcare System Gangnam Center , Seoul ,","place":["Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyun Jung","family":"Lee","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Seoul National University Hospital , Seoul ,","place":["Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hee-Sun","family":"Lee","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Seoul National University Hospital Healthcare System Gangnam Center , Seoul ,","place":["Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun-Bean","family":"Park","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Seoul National University Hospital , Seoul ,","place":["Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong-Jin","family":"Kim","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Seoul National University Hospital , Seoul ,","place":["Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyungdo","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Statistics and Actuarial Science, Soongsil University , Seoul ,","place":["Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7950-2131","authenticated-orcid":false,"given":"Hyung-Kwan","family":"Kim","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Seoul National University Hospital , Seoul ,","place":["Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,7,25]]},"reference":[{"key":"2026012113121063600_ehf215004-bib-0001","doi-asserted-by":"publisher","first-page":"2102","DOI":"10.1016\/S0140-6736(21)01205-8","article-title":"Hypertrophic cardiomyopathy: a practical approach to guideline directed management","volume":"398","author":"Ommen","year":"2021","journal-title":"Lancet"},{"key":"2026012113121063600_ehf215004-bib-0002","doi-asserted-by":"publisher","first-page":"563","DOI":"10.4070\/kcj.2022.0159","article-title":"Major clinical issues in hypertrophic cardiomyopathy","volume":"52","author":"Lee","year":"2022","journal-title":"Korean Circ J"},{"key":"2026012113121063600_ehf215004-bib-0003","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1016\/S0140-6736(12)60397-3","article-title":"Hypertrophic cardiomyopathy","volume":"381","author":"Maron","year":"2013","journal-title":"Lancet"},{"key":"2026012113121063600_ehf215004-bib-0004","doi-asserted-by":"publisher","first-page":"2313","DOI":"10.1016\/j.jacc.2011.08.040","article-title":"Long-term survival in patients with resting obstructive hypertrophic cardiomyopathy comparison of conservative versus invasive treatment","volume":"58","author":"Ball","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"2026012113121063600_ehf215004-bib-0005","doi-asserted-by":"publisher","first-page":"1849","DOI":"10.1177\/2047487319889714","article-title":"Obesity and metabolic health status are determinants for the clinical expression of hypertrophic cardiomyopathy","volume":"27","author":"Park","year":"2020","journal-title":"Eur J Prev Cardiol"},{"key":"2026012113121063600_ehf215004-bib-0006","doi-asserted-by":"publisher","first-page":"1507","DOI":"10.1016\/j.amjcard.2006.07.029","article-title":"Determinants for clinical diagnosis of hypertrophic cardiomyopathy","volume":"98","author":"Adabag","year":"2006","journal-title":"Am J Cardiol"},{"key":"2026012113121063600_ehf215004-bib-0007","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1016\/j.jacc.2013.03.062","article-title":"Obesity and its association to phenotype and clinical course in hypertrophic cardiomyopathy","volume":"62","author":"Olivotto","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"2026012113121063600_ehf215004-bib-0008","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2023.131574","article-title":"Age-dependent association of metabolic dyslipidemia with clinical expression of hypertrophic cardiomyopathy","volume":"396","author":"Kwak","year":"2023","journal-title":"Int J Cardiol"},{"key":"2026012113121063600_ehf215004-bib-0009","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.jacc.2004.10.031","article-title":"Efficacy and safety of high-density lipoprotein cholesterol-increasing compounds: a meta-analysis of randomized controlled trials","volume":"45","author":"Birjmohun","year":"2005","journal-title":"J Am Coll Cardiol"},{"key":"2026012113121063600_ehf215004-bib-0010","doi-asserted-by":"publisher","first-page":"1849","DOI":"10.1016\/S0140-6736(05)67667-2","article-title":"Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial","volume":"366","author":"Keech","year":"2005","journal-title":"Lancet"},{"key":"2026012113121063600_ehf215004-bib-0011","doi-asserted-by":"publisher","first-page":"1563","DOI":"10.1056\/NEJMoa1001282","article-title":"Effects of combination lipid therapy in type 2 diabetes mellitus","volume":"362","author":"Group AS","year":"2010","journal-title":"N Engl J Med"},{"key":"2026012113121063600_ehf215004-bib-0012","doi-asserted-by":"publisher","first-page":"1875","DOI":"10.1016\/S0140-6736(10)60656-3","article-title":"Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis","volume":"375","author":"Jun","year":"2010","journal-title":"Lancet"},{"key":"2026012113121063600_ehf215004-bib-0013","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1016\/j.atherosclerosis.2011.04.020","article-title":"Efficacy of fibrates for cardiovascular risk reduction in persons with atherogenic dyslipidemia: a meta-analysis","volume":"217","author":"Lee","year":"2011","journal-title":"Atherosclerosis"},{"key":"2026012113121063600_ehf215004-bib-0014","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.2337\/dc21-2299","article-title":"U-shaped associations between body weight changes and major cardiovascular events in type 2 diabetes mellitus: a longitudinal follow-up study of a nationwide cohort of over 1.5 million","volume":"45","author":"Park","year":"2022","journal-title":"Diabetes Care"},{"key":"2026012113121063600_ehf215004-bib-0015","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0227012","article-title":"Trends of the prevalence and incidence of hypertrophic cardiomyopathy in Korea: a nationwide population-based cohort study","volume":"15","author":"Moon","year":"2020","journal-title":"PLoS ONE"},{"key":"2026012113121063600_ehf215004-bib-0016","doi-asserted-by":"publisher","first-page":"6412","DOI":"10.1038\/s41598-023-33344-3","article-title":"Impact of coronary artery revascularization on long-term outcome in hypertrophic cardiomyopathy patients: a nationwide population-based cohort study","volume":"13","author":"Rhee","year":"2023","journal-title":"Sci Rep"},{"key":"2026012113121063600_ehf215004-bib-0017","doi-asserted-by":"publisher","first-page":"4854","DOI":"10.1038\/s41598-021-84335-1","article-title":"Sex differences in the prognosis of patients with hypertrophic cardiomyopathy","volume":"11","author":"Kim","year":"2021","journal-title":"Sci Rep"},{"key":"2026012113121063600_ehf215004-bib-0018","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/j.ijcard.2018.08.038","article-title":"Temporal trends of the prevalence and incidence of atrial fibrillation and stroke among Asian patients with hypertrophic cardiomyopathy: a nationwide population-based study","volume":"273","author":"Choi","year":"2018","journal-title":"Int J Cardiol"},{"key":"2026012113121063600_ehf215004-bib-0019","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.ijcard.2020.04.085","article-title":"De novo malignancy risk in patients undergoing the first percutaneous coronary intervention: a nationwide population-based cohort study","volume":"313","author":"Kwak","year":"2020","journal-title":"Int J Cardiol"},{"key":"2026012113121063600_ehf215004-bib-0020","doi-asserted-by":"publisher","first-page":"1479","DOI":"10.1093\/eurjpc\/zwac094","article-title":"Age-dependent associations of body mass index with myocardial infarction, heart failure, and mortality in over 9 million Koreans","volume":"29","author":"Lee","year":"2022","journal-title":"Eur J Prev Cardiol"},{"key":"2026012113121063600_ehf215004-bib-0021","doi-asserted-by":"publisher","first-page":"1892","DOI":"10.1136\/heartjnl-2019-315160","article-title":"Validation of the hypertrophic cardiomyopathy risk-sudden cardiac death calculator in Asians","volume":"105","author":"Choi","year":"2019","journal-title":"Heart"},{"key":"2026012113121063600_ehf215004-bib-0022","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.121.013556","article-title":"Left atrial reservoir strain-based left ventricular diastolic function grading and incident heart failure in hypertrophic cardiomyopathy","volume":"15","author":"Lee","year":"2022","journal-title":"Circ Cardiovasc Imaging"},{"key":"2026012113121063600_ehf215004-bib-0023","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1016\/S0140-6736(20)31792-X","article-title":"Mavacamten for treatment of symptomatic obstructive hypertrophic cardiomyopathy (EXPLORER-HCM): a randomised, double-blind, placebo-controlled, phase 3 trial","volume":"396","author":"Olivotto","year":"2020","journal-title":"Lancet"},{"key":"2026012113121063600_ehf215004-bib-0024","doi-asserted-by":"publisher","first-page":"741","DOI":"10.7326\/M18-3016","article-title":"Mavacamten treatment for obstructive hypertrophic cardiomyopathy: a clinical trial","volume":"170","author":"Heitner","year":"2019","journal-title":"Ann Intern Med"},{"key":"2026012113121063600_ehf215004-bib-0025","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1016\/j.jacc.2020.06.011","article-title":"Penetrance of hypertrophic cardiomyopathy in sarcomere protein mutation carriers","volume":"76","author":"Lorenzini","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2026012113121063600_ehf215004-bib-0026","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0187948","article-title":"Hypertrophic cardiomyopathy clinical phenotype is independent of gene mutation and mutation dosage","volume":"12","author":"Viswanathan","year":"2017","journal-title":"PLoS ONE"},{"key":"2026012113121063600_ehf215004-bib-0027","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1007\/BF00544015","article-title":"Effects of clofibrate, bezafibrate, fenofibrate and probucol on plasma lipolytic enzymes in normolipaemic subjects","volume":"25","author":"Heller","year":"1983","journal-title":"Eur J Clin Pharmacol"},{"key":"2026012113121063600_ehf215004-bib-0028","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l5125","article-title":"Use of fenofibrate on cardiovascular outcomes in statin users with metabolic syndrome: propensity matched cohort study","volume":"366","author":"Kim","year":"2019","journal-title":"BMJ"},{"key":"2026012113121063600_ehf215004-bib-0029","doi-asserted-by":"publisher","first-page":"23915","DOI":"10.1074\/jbc.M116.745778","article-title":"Fenofibrate decreases insulin clearance and insulin secretion to maintain insulin sensitivity","volume":"291","author":"Ramakrishnan","year":"2016","journal-title":"J Biol Chem"},{"key":"2026012113121063600_ehf215004-bib-0030","doi-asserted-by":"publisher","first-page":"397","DOI":"10.3858\/emm.2009.41.6.045","article-title":"Fenofibrate inhibits adipocyte hypertrophy and insulin resistance by activating adipose PPARalpha in high fat diet-induced obese mice","volume":"41","author":"Jeong","year":"2009","journal-title":"Exp Mol Med"},{"key":"2026012113121063600_ehf215004-bib-0031","doi-asserted-by":"publisher","first-page":"2266","DOI":"10.2337\/dc10-0272","article-title":"Pleiotropic effects of atorvastatin and fenofibrate in metabolic syndrome and different types of pre-diabetes","volume":"33","author":"Krysiak","year":"2010","journal-title":"Diabetes Care"},{"key":"2026012113121063600_ehf215004-bib-0032","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1016\/j.phrs.2017.12.030","article-title":"Effect of fibrates on glycemic parameters: a systematic review and meta-analysis of randomized placebo-controlled trials","volume":"132","author":"Simental-Mend\u00eda","year":"2018","journal-title":"Pharmacol Res"},{"key":"2026012113121063600_ehf215004-bib-0033","doi-asserted-by":"publisher","first-page":"1010","DOI":"10.1016\/j.amjcard.2010.11.023","article-title":"Effect of simvastatin and fenofibrate on cytokine release and systemic inflammation in type 2 diabetes mellitus with mixed dyslipidemia","volume":"107","author":"Krysiak","year":"2011","journal-title":"Am J Cardiol"},{"key":"2026012113121063600_ehf215004-bib-0034","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1161\/01.CIR.96.3.874","article-title":"Overexpression of transforming growth factor-beta1 and insulin-like growth factor-I in patients with idiopathic hypertrophic cardiomyopathy","volume":"96","author":"Li","year":"1997","journal-title":"Circulation"},{"key":"2026012113121063600_ehf215004-bib-0035","doi-asserted-by":"publisher","first-page":"768","DOI":"10.2337\/dc11-1833","article-title":"The association between IGF-I and insulin resistance: a general population study in Danish adults","volume":"35","author":"Friedrich","year":"2012","journal-title":"Diabetes Care"},{"key":"2026012113121063600_ehf215004-bib-0036","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.cmet.2011.04.013","article-title":"Protection from obesity and diabetes by blockade of TGF-beta\/Smad3 signaling","volume":"14","author":"Yadav","year":"2011","journal-title":"Cell Metab"},{"key":"2026012113121063600_ehf215004-bib-0037","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1016\/j.metabol.2007.11.018","article-title":"Association among cigarette smoking, metabolic syndrome, and its individual components: the metabolic syndrome study in Taiwan","volume":"57","author":"Chen","year":"2008","journal-title":"Metabolism"},{"key":"2026012113121063600_ehf215004-bib-0038","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1186\/1471-2458-11-489","article-title":"Alcohol use behaviors and risk of metabolic syndrome in South Korean middle-aged men","volume":"11","author":"Kim","year":"2011","journal-title":"BMC Public Health"},{"key":"2026012113121063600_ehf215004-bib-0039","doi-asserted-by":"publisher","first-page":"695","DOI":"10.5551\/jat.3517","article-title":"Cross-sectional relationship between alcohol consumption and prevalence of metabolic syndrome in Japanese men and women","volume":"17","author":"Wakabayashi","year":"2010","journal-title":"J Atheroscler Thromb"},{"key":"2026012113121063600_ehf215004-bib-0040","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0168925","article-title":"Physical activity and sedentary behavior associated with components of metabolic syndrome among people in rural China","volume":"11","author":"Xiao","year":"2016","journal-title":"PLoS ONE"}],"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/11\/6\/3972\/64517231\/eschf_11_6_3972.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/11\/6\/3972\/64517231\/eschf_11_6_3972.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T18:14:12Z","timestamp":1769019252000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/article\/11\/6\/3972\/8269365"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,25]]},"references-count":40,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,7,25]]},"published-print":{"date-parts":[[2024,12,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ehf2.15004","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,12]]},"published":{"date-parts":[[2024,7,25]]},"assertion":[{"value":"2024-01-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}