{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:08:45Z","timestamp":1781050125114,"version":"3.54.1"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"17","license":[{"start":{"date-parts":[[2020,11,1]],"date-time":"2020-11-01T00:00:00Z","timestamp":1604188800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2020,11,1]],"date-time":"2020-11-01T00:00:00Z","timestamp":1604188800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,11,1]]},"abstract":"<jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>We sought to investigate the association of obesity and metabolic health status with the incidence of clinical hypertrophic cardiomyopathy (HCM) diagnosis in the general population. Our goal was to identify modifiable risk factors to attenuate clinical expression of HCM, enabling management evolution from a mostly passive strategy of risk stratification to a proactive strategy of modifying disease expression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Using nationwide population-based data from the Korean National Health Insurance Service, 28,679,891 people who were free of prevalent HCM and who underwent health examinations between 2009 and 2015 were followed until 31 December 2016. The primary outcome was clinical HCM that was defined as incident diagnosis of HCM during the follow-up, after a blanking period of 12 months.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Over a median follow-up of 5.2 years, 0.027% (n\u2009=\u20097851) of the study participants were diagnosed as incident HCM. The incidence rate per 1000 person-years was 0.059. A significant association was found between body mass index (BMI) and the incidence of clinical HCM after multivariate adjustment, with a hazard ratio per 1\u2009kg\/m2 increase in BMI of 1.063 (95% confidence interval 1.051\u20131.075). Metabolically unhealthy participants had a greater incidence of HCM than metabolically healthy participants, regardless of obesity status. The effect of BMI was more pronounced in several subgroups, including participants with no hypertension, those aged less than 65 years and men.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>We found that individuals with obesity and\/or metabolic abnormalities had a significantly higher incidence of clinical HCM diagnosis than their counterparts. Efforts to manage obesity and metabolic abnormalities may be important in modifying clinical expression of HCM.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1177\/2047487319889714","type":"journal-article","created":{"date-parts":[[2019,12,2]],"date-time":"2019-12-02T11:38:12Z","timestamp":1575286692000},"page":"1849-1857","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":51,"title":["Obesity and metabolic health status are determinants for the clinical expression of hypertrophic cardiomyopathy"],"prefix":"10.1093","volume":"27","author":[{"given":"Jun-Bean","family":"Park","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea"},{"name":"Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Da Hye","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heesun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea"},{"name":"Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In-Chang","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea"},{"name":"Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeonyee E","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea"},{"name":"Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyo Eun","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea"},{"name":"Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su-Yeon","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea"},{"name":"Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong-Jin","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea"},{"name":"Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Goo-Yeong","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea"},{"name":"Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyungdo","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve R","family":"Ommen","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyung-Kwan","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea"},{"name":"Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,11,1]]},"reference":[{"issue":"3","key":"2021020116501309200_bibr1-2047487319889714","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.jcmg.2009.10.012","article-title":"The impact of obesity on the left ventricle: The multi-ethnic study of atherosclerosis (MESA)","volume":"3","author":"Turkbey","year":"2010","journal-title":"JACC Cardiovasc Imaging"},{"issue":"4","key":"2021020116501309200_bibr2-2047487319889714","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1177\/2047487317751291","article-title":"Obesity and sudden cardiac death in the young: Clinical and pathological insights from a large national registry","volume":"25","author":"Finocchiaro","year":"2018","journal-title":"Eur J Prev Cardiol"},{"issue":"3","key":"2021020116501309200_bibr3-2047487319889714","doi-asserted-by":"crossref","first-page":"H1206","DOI":"10.1152\/ajpheart.00319.2008","article-title":"Hypertrophic cardiomyopathy in high-fat diet-induced obesity: role of suppression of forkhead transcription factor and atrophy gene transcription","volume":"295","author":"Fang","year":"2008","journal-title":"Am J Physiol Heart Circ Physiol"},{"issue":"4","key":"2021020116501309200_bibr4-2047487319889714","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1161\/01.RES.0000205766.97556.00","article-title":"Exercise can prevent and reverse the severity of hypertrophic cardiomyopathy","volume":"98","author":"Konhilas","year":"2006","journal-title":"Circ Res"},{"issue":"5","key":"2021020116501309200_bibr5-2047487319889714","doi-asserted-by":"crossref","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":"2021020116501309200_bibr6-2047487319889714","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1016\/j.ijcard.2016.04.036","article-title":"Underweight is a risk factor for atrial fibrillation: A nationwide population-based study","volume":"215","author":"Kang","year":"2016","journal-title":"Int J Cardiol"},{"issue":"12","key":"2021020116501309200_bibr7-2047487319889714","doi-asserted-by":"crossref","first-page":"e0190182","DOI":"10.1371\/journal.pone.0190182","article-title":"Cancer risk in Korean patients with Behcet's disease: A nationwide population-based study","volume":"12","author":"Jung","year":"2017","journal-title":"PLoS One"},{"key":"2021020116501309200_bibr8-2047487319889714","doi-asserted-by":"crossref","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"},{"issue":"12","key":"2021020116501309200_bibr9-2047487319889714","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1016\/j.jacc.2017.07.763","article-title":"Metabolically healthy obese and incident cardiovascular disease events among 3.5 million men and women","volume":"70","author":"Caleyachetty","year":"2017","journal-title":"J Am Coll Cardiol"},{"issue":"2","key":"2021020116501309200_bibr10-2047487319889714","doi-asserted-by":"crossref","first-page":"93","DOI":"10.4093\/dmj.2018.42.2.93","article-title":"Past and current status of adult type 2 diabetes mellitus management in Korea: A National Health Insurance Service database analysis","volume":"42","author":"Ko","year":"2018","journal-title":"Diabetes Metab J"},{"issue":"10","key":"2021020116501309200_bibr11-2047487319889714","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1016\/j.amjcard.2016.02.044","article-title":"Occurrence of clinically diagnosed hypertrophic cardiomyopathy in the United States","volume":"117","author":"Maron","year":"2016","journal-title":"Am J Cardiol"},{"issue":"2","key":"2021020116501309200_bibr12-2047487319889714","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.jchf.2013.01.006","article-title":"Impact of obesity and the obesity paradox on prevalence and prognosis in heart failure","volume":"1","author":"Lavie","year":"2013","journal-title":"JACC Heart Fail"},{"issue":"9","key":"2021020116501309200_bibr13-2047487319889714","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1016\/0002-9149(92)90739-L","article-title":"Cardiomyopathy of obesity: a clinicopathologic evaluation of 43 obese patients with heart failure","volume":"70","author":"Kasper","year":"1992","journal-title":"Am J Cardiol"},{"issue":"16","key":"2021020116501309200_bibr14-2047487319889714","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1016\/S0002-9149(99)80339-7","article-title":"Effect of weight loss on left ventricular diastolic filling in morbid obesity","volume":"76","author":"Alpert","year":"1995","journal-title":"Am J Cardiol"},{"issue":"2","key":"2021020116501309200_bibr15-2047487319889714","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1001\/jama.1991.03470020057032","article-title":"The impact of obesity on left ventricular mass and geometry. The Framingham Heart Study","volume":"266","author":"Lauer","year":"1991","journal-title":"JAMA"},{"issue":"5","key":"2021020116501309200_bibr16-2047487319889714","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/j.jchf.2014.03.001","article-title":"Association of obesity in early adulthood and middle age with incipient left ventricular dysfunction and structural remodeling: the CARDIA study (Coronary Artery Risk Development in Young Adults)","volume":"2","author":"Kishi","year":"2014","journal-title":"JACC Heart Fail"},{"issue":"15","key":"2021020116501309200_bibr17-2047487319889714","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1016\/j.jacc.2013.07.042","article-title":"Childhood obesity and cardiovascular dysfunction","volume":"62","author":"Cote","year":"2013","journal-title":"J Am Coll Cardiol"},{"issue":"3","key":"2021020116501309200_bibr18-2047487319889714","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1001\/jama.2017.6119","article-title":"Obesity and excessive weight gain in young adults: new targets for prevention","volume":"318","author":"Dietz","year":"2017","journal-title":"JAMA"},{"issue":"3","key":"2021020116501309200_bibr19-2047487319889714","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S2213-8587(17)30292-9","article-title":"Metabolically healthy obesity: the low-hanging fruit in obesity treatment?","volume":"6","author":"Stefan","year":"2018","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"3","key":"2021020116501309200_bibr20-2047487319889714","doi-asserted-by":"crossref","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"},{"issue":"4","key":"2021020116501309200_bibr21-2047487319889714","doi-asserted-by":"crossref","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"},{"issue":"1","key":"2021020116501309200_bibr22-2047487319889714","doi-asserted-by":"crossref","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"},{"issue":"7","key":"2021020116501309200_bibr23-2047487319889714","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1253\/circj.68.650","article-title":"Insulin resistance in patients with hypertrophic cardiomyopathy","volume":"68","author":"Murakami","year":"2004","journal-title":"Circ J"},{"issue":"7","key":"2021020116501309200_bibr24-2047487319889714","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/0002-9149(94)90676-9","article-title":"Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women","volume":"73","author":"Pouliot","year":"1994","journal-title":"Am J Cardiol"}],"container-title":["European Journal of Preventive Cardiology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2047487319889714","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/2047487319889714","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/academic.oup.com\/eurjpc\/article-pdf\/27\/17\/1849\/36165502\/eurjpc1849.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/eurjpc\/article-pdf\/27\/17\/1849\/36165502\/eurjpc1849.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T00:37:01Z","timestamp":1618879021000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurjpc\/article\/27\/17\/1849-1857\/6125527"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,1]]},"references-count":24,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2020,11,1]]},"published-print":{"date-parts":[[2020,11,1]]}},"URL":"https:\/\/doi.org\/10.1177\/2047487319889714","relation":{},"ISSN":["2047-4881","2047-4873"],"issn-type":[{"value":"2047-4881","type":"electronic"},{"value":"2047-4873","type":"print"}],"subject":[],"published-other":{"date-parts":[[2020,11,1]]},"published":{"date-parts":[[2020,11,1]]}}}