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Obesity and short-term cardiovascular outcomes among mavacamten-treated patients with obstructive hypertrophic cardiomyopathy: a propensity-matched cohort study
Open accessAbstract
Obesity is common in hypertrophic cardiomyopathy (HCM) and is typically linked to adverse outcomes, but its impact in patients treated with mavacamten remains unclear. Using the TriNetX Global Collaborative Network, we identified adults with obstructive HCM (ICD-10-CM: I42.1) who had a documented mavacamten prescription. The index date was defined as the date of the first documented prescription. BMI classification used the closest BMI recorded within 365 days before or on the index date; post-index BMI values were not used. Patients were stratified by BMI (≥ 30 vs. <30 kg/m²) and matched 1:1 using propensity scores. Outcomes were assessed from 1 day after the index date through the last recorded clinical encounter or event of interest. After matching, 291 patients were included in each BMI group. Median follow-up was 315 days in the BMI ≥ 30 kg/m² group and 322 days in the BMI < 30 kg/m² group (overall median, 318 days; IQR, 110–485 days). All-cause mortality occurred in 10/291 patients in each group (platform-reported risk, 3.4% vs. 3.5%; HR 0.47, 95% CI 0.12–1.87). Kaplan-Meier survival did not differ between groups (log-rank p = 0.21). No statistically significant between-group differences were observed for myocardial infarction, stroke, venous thromboembolism, acute kidney injury, hypotension, AF/AFL, or VT/VF. The sensitivity analysis comparing BMI ≥ 35 with BMI 25–34.9 kg/m² also identified no statistically significant differences, although event rates were low and confidence intervals were wide. No statistically significant between-group differences were observed in the selected short-term coded clinical outcomes among patients with obstructive HCM and a documented mavacamten prescription. However, the short follow-up, low event rates, and wide confidence intervals preclude conclusions regarding equivalence, comparative treatment efficacy, pharmacologic response, formal medication tolerability, or long-term safety across BMI categories.
Overview
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Written from the paper’s full text.
TL;DR
In a propensity-matched TriNetX cohort of adults with obstructive hypertrophic cardiomyopathy and a documented mavacamten prescription, obesity (BMI ≥ 30 kg/m²) was not associated with any statistically significant difference in short-term coded cardiovascular outcomes compared with BMI < 30 kg/m². The authors caution that short follow-up, low event rates, and wide confidence intervals preclude conclusions about equivalence, efficacy, tolerability, or long-term safety.
Key findings
- After 1:1 propensity-score matching, 291 patients were included in each BMI group; median follow-up was 315 days (BMI ≥ 30) vs 322 days (BMI < 30), overall median 318 days (IQR 110–485).
- All-cause mortality occurred in 10/291 patients in each group (platform-reported risk 3.4% vs 3.5%; HR 0.47, 95% CI 0.12–1.87), with no difference in Kaplan-Meier survival (log-rank p = 0.21).
- No statistically significant between-group differences were observed for myocardial infarction, stroke, venous thromboembolism, acute kidney injury, hypotension, AF/AFL, or VT/VF.
- A sensitivity analysis comparing BMI ≥ 35 with BMI 25–34.9 kg/m² also found no statistically significant differences, though event rates were low and confidence intervals wide.
Methods
- Retrospective cohort using the TriNetX Global Collaborative Network; adults with obstructive HCM (ICD-10-CM: I42.1) and a documented mavacamten prescription were identified, with the index date set as the first documented prescription.
- BMI classification used the closest BMI recorded within 365 days before or on the index date (post-index BMI values not used); patients were stratified by BMI (≥ 30 vs < 30 kg/m²) and matched 1:1 using propensity scores.
- Outcomes were assessed from 1 day after the index date through the last recorded clinical encounter or event of interest.
Limitations
- Stated by the paper: short follow-up, low event rates, and wide confidence intervals preclude conclusions regarding equivalence, comparative treatment efficacy, pharmacologic response, formal medication tolerability, or long-term safety across BMI categories.
- Evident from the text: reliance on ICD-10-CM codes and platform-reported outcomes in a claims/EHR network, and the use of a single pre-index BMI value, may misclassify exposures and outcomes; the abstract does not report the specific covariates included in the propensity model.
Model-written summary. Check it against the paper before relying on it.
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Claims the paper makes
- Findingown data§ Results
Kaplan-Meier survival did not differ between the BMI ≥ 30 kg/m2 and BMI < 30 kg/m2 groups (log-rank p = 0.21).
“Kaplan-Meier survival did not differ between groups (log-rank p = 0.21).”
Quote in the paperSubstantial claim - Findingown data§ Results
Among propensity-matched patients with obstructive HCM and a documented mavacamten prescription, no statistically significant between-group differences by BMI were observed for myocardial infarction, stroke, venous thromboembolism, acute kidney injury, hypotension, AF/AFL, or VT/VF.
“No statistically significant between-group differences were observed for myocardial infarction, stroke, venous thromboembolism, acute kidney injury, hypotension, AF/AFL, or VT/VF.”
- Also stated in: § Conclusion · plain
“No statistically significant between-group differences were observed in the selected short-term coded clinical outcomes among patients with obstructive HCM and a documented mavacamten prescription.”
Quote in the paperSubstantial claim - Also stated in: § Conclusion · plain
- It may state two separate claims as one. 6
- Probably not a substantial claim. 4
It may state two separate claims as one.
Findingown data§ ResultsIn a sensitivity analysis comparing BMI ≥ 35 with BMI 25-34.9 kg/m2, no statistically significant between-group differences were identified, although event rates were low and confidence intervals were wide.
“The sensitivity analysis comparing BMI ≥ 35 with BMI 25–34.9 kg/m² also identified no statistically significant differences, although event rates were low and confidence intervals were wide.”
Quote in the paperNot a substantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
Findingown data§ ResultsMedian follow-up was 315 days in the BMI ≥ 30 kg/m2 group and 322 days in the BMI < 30 kg/m2 group (overall median 318 days; IQR 110-485 days).
“Median follow-up was 315 days in the BMI ≥ 30 kg/m² group and 322 days in the BMI < 30 kg/m² group (overall median, 318 days; IQR, 110–485 days).”
Quote in the paperNot a substantial claimIt may state two separate claims as one.
Findingown data§ ResultsAll-cause mortality occurred in 10/291 patients in each BMI group (platform-reported risk 3.4% vs. 3.5%; HR 0.47, 95% CI 0.12-1.87).
“All-cause mortality occurred in 10/291 patients in each group (platform-reported risk, 3.4% vs. 3.5%; HR 0.47, 95% CI 0.12–1.87).”
Quote in the paperSubstantial claimProbably not a substantial claim.
Findingown data§ ResultsAfter propensity-score matching, 291 patients were included in each BMI group (BMI ≥ 30 kg/m2 and BMI < 30 kg/m2).
“After matching, 291 patients were included in each BMI group.”
Quote in the paperSubstantial claimIt may state two separate claims as one.
Interpretationown data§ ConclusionThe short follow-up, low event rates, and wide confidence intervals preclude conclusions regarding equivalence, comparative treatment efficacy, pharmacologic response, formal medication tolerability, or long-term safety across BMI categories.
“However, the short follow-up, low event rates, and wide confidence intervals preclude conclusions regarding equivalence, comparative treatment efficacy, pharmacologic response, formal medication tolerability, or long-term safety across BMI categories.”
Quote in the paperSubstantial claimProbably not a substantial claim. It may state two separate claims as one.
Study design and conductnone given§ MethodsBMI classification used the closest BMI recorded within 365 days before or on the index date, and post-index BMI values were not used.
“BMI classification used the closest BMI recorded within 365 days before or on the index date; post-index BMI values were not used.”
Quote in the paperSubstantial claimProbably not a substantial claim. It may state two separate claims as one.
Study design and conductnone given§ MethodsPatients were stratified by BMI (≥ 30 vs. < 30 kg/m2) and matched 1:1 using propensity scores.
“Patients were stratified by BMI (≥ 30 vs. <30 kg/m²) and matched 1:1 using propensity scores.”
Quote in the paperSubstantial claim
The paper relies on this without support.
The impact of obesity on outcomes in patients with obstructive HCM treated with mavacamten remains unclear (a knowledge gap exists).
“but its impact in patients treated with mavacamten remains unclear”
The paper relies on this without support.
Obesity is common in hypertrophic cardiomyopathy and is typically linked to adverse outcomes.
“Obesity is common in hypertrophic cardiomyopathy (HCM) and is typically linked to adverse outcomes”
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Metadata
- Authors
- Abumuhfouz, M., Abughazaleh, S., Fael, M., Sena, A., Suleiman, S., Baniowda, M., Azzam, A., Adler, R., Shaban, E., Alkhdour, O., & Asif, T.
- Affiliations
- University of Missouri–Kansas City (US)
- University of Massachusetts System (US)
- Saint Luke's Hospital (US)
- Corresponding author
- Abumuhfouz, Ma’in
- Venue
- BMC Cardiovascular Disorders
- Published
- 2026-09-14
- ISSN
- 1471-2261 (ISSN-L)
- OpenAlex
- W7213084728
- Cited by
- 0
- References
- 0
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Cardiovascular Disorders (publishedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Keywords
- obesity, hypertrophic obstructive cardiomyopathy, mavacamten, body mass index, all-cause mortality, cardiovascular outcomes, short-term safety, propensity score matching
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