Abstract：
OBJECTIVE: 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.
METHODS: 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-naïve participants (n = 412 823). After a 1 year lag period, we identified the incident HCM cases for the following 5 years.
RESULTS: 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 (0.630-0.924)]. In subgroup analyses, fibrate use was associated with a reduced risk of clinical HCM expression in patients with a body mass index ≥25 kg/m2 and those with abdominal obesity [HR (95% CI): 0.719 (0.553-0.934) and 0.655 (0.492-0.872)], but not in those without obesity. Fibrate use was also associated with lower risks of incident clinical HCM in patients with triglyceride levels ≥150 mg/dL and those with metabolic syndrome [HR (95% CI): 0.741 (0.591-0.929) and 0.750 (0.609-0.923)], 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.
CONCLUSIONS: 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.
METHODS: 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-naïve participants (n = 412 823). After a 1 year lag period, we identified the incident HCM cases for the following 5 years.
RESULTS: 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 (0.630-0.924)]. In subgroup analyses, fibrate use was associated with a reduced risk of clinical HCM expression in patients with a body mass index ≥25 kg/m2 and those with abdominal obesity [HR (95% CI): 0.719 (0.553-0.934) and 0.655 (0.492-0.872)], but not in those without obesity. Fibrate use was also associated with lower risks of incident clinical HCM in patients with triglyceride levels ≥150 mg/dL and those with metabolic syndrome [HR (95% CI): 0.741 (0.591-0.929) and 0.750 (0.609-0.923)], 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.
CONCLUSIONS: 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.
摘要：
目的：肥胖，代谢异常和临床肥厚型心肌病（HCM）的表达已有报道。我们研究了用贝特类药物治疗血脂异常是否会影响HCM的临床表达。
方法：我们从全国数据库中筛选了2010年至2017年间使用贝特类药物的患者。排除有HCM病史的患者后，我们确定了贝特类药物使用者组(n=412.823).然后，我们构建了一个1：1匹配的贝特患者队列（n=412.823）。经过1年的滞后期，我们确定了接下来5年的HCM病例.
结果：在3.96年的中位随访期内，我们确定了454例临床HCM事件。在调整协变量后，贝特类药物的使用与较低的临床HCM表达风险相关[风险比(HR)95%置信区间(CI):0.763(0.630-0.924)].在亚组分析中，在体重指数≥25kg/m2的患者和腹型肥胖患者中，贝特类药物的使用与临床HCM表达风险降低相关[HR（95％CI）：0.719（0.553-0.934）和0.655（0.492-0.872）]，但不是那些没有肥胖的人。在甘油三酯水平≥150mg/dL的患者和代谢综合征患者中，使用纤维蛋白也与较低的临床HCM发生率相关[HR（95％CI）：0.741（0.591-0.929）和0.750（0.609-0.923）]，但不是在他们的同行。关于生活方式行为，贝特类药物的使用似乎为目前吸烟的患者提供了更多的预后益处，饮酒或不从事定期体育活动。
结论：贝特类药物的使用与临床HCM表达的发生率较低相关。这种关联在肥胖患者中也更为突出，不健康的代谢特征和不良的生活方式。
方法：我们从全国数据库中筛选了2010年至2017年间使用贝特类药物的患者。排除有HCM病史的患者后，我们确定了贝特类药物使用者组(n=412.823).然后，我们构建了一个1：1匹配的贝特患者队列（n=412.823）。经过1年的滞后期，我们确定了接下来5年的HCM病例.
结果：在3.96年的中位随访期内，我们确定了454例临床HCM事件。在调整协变量后，贝特类药物的使用与较低的临床HCM表达风险相关[风险比(HR)95%置信区间(CI):0.763(0.630-0.924)].在亚组分析中，在体重指数≥25kg/m2的患者和腹型肥胖患者中，贝特类药物的使用与临床HCM表达风险降低相关[HR（95％CI）：0.719（0.553-0.934）和0.655（0.492-0.872）]，但不是那些没有肥胖的人。在甘油三酯水平≥150mg/dL的患者和代谢综合征患者中，使用纤维蛋白也与较低的临床HCM发生率相关[HR（95％CI）：0.741（0.591-0.929）和0.750（0.609-0.923）]，但不是在他们的同行。关于生活方式行为，贝特类药物的使用似乎为目前吸烟的患者提供了更多的预后益处，饮酒或不从事定期体育活动。
结论：贝特类药物的使用与临床HCM表达的发生率较低相关。这种关联在肥胖患者中也更为突出，不健康的代谢特征和不良的生活方式。
