Based on the new breakthrough that some anti-diabetic drugs are associated with a lower risk of heart failure hospitalization in patients with cardiovascular disease, we also discuss PPARα-related drugs that may be risky (such as fenofibrate, bezafibrate, clofibrate) or relatively safer (pemafibrate, metformin and glucagon-like peptide 1-receptor (GLP-1R) agonists) or drugs that may have the potential (sodium–glucose co-transpoter 2 inhibitors:SGLT2i) in treating DCM. This evidence concerns the gene PPARA and familial dilated cardiomyopathy.