Sex and Gender Differences in Myocarditis and Dilated Cardiomyopathy
Open accessAbstract
Heart failure due to nonischemic dilated cardiomyopathy (DCM) contributes significantly to the global burden of cardiovascular disease. Myocarditis is, in turn, a major cause of acute DCM in both men and women. However, recent clinical and experimental evidence suggests that the pathogenesis and prognosis of DCM differ between the sexes. This seminar provides a contemporary perspective on the immune mediators of myocarditis, including interdependent elements of the innate and adaptive immune response. The heart's acute response to injury is influenced by sex hormones that appear to determine the subsequent risk of chronic DCM. Preliminary data suggest additional genetic variations may account for some of the differences in epidemiology, left ventricular recovery, and survival between men and women. We highlight the gaps in our knowledge regarding the management of women with acute DCM and discuss emerging therapies, including bromocriptine for the treatment of peripartum cardiomyopathy.
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Male mice develop more consistent and severe EAM than females, exhibiting stronger pro-inflammatory macrophage responses, greater cardiac infiltration, and more pronounced fibrotic remodelling.
“This was a deliberate experimental decision, as male mice develop more consistent and severe EAM than females, exhibiting stronger pro-inflammatory macrophage responses, greater cardiac infiltration, and more pronounced fibrotic remodelling, which are features that are well-documented in both autoimmune and viral myocarditis models and align with the higher incidence and severity of myocarditis”
From Cardiac Macrophages Exhibit Dynamic Heterogeneity and Functional Specialization During Experimental Autoimmune Myocarditis. (2026) · cites this paper as [33]
The Myocardial inflammation section reports greater cardiac inflammation and more M1 macrophages in male than female BALB/c mice with CVB3-induced myocarditis. Cardiac remodeling reports fibrosis and DCM in males of susceptible strains after CVB3 infection, but not in female BALB/c mice. These passages concern a viral model; they do not establish that male mice develop more consistent or severe EAM, or that all the listed features occur in the autoimmune model. Page numbers were not available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredWomen are more likely to develop myocarditis after menopause.
“while women are more likely to develop myocarditis after menopause, which is reviewed in previous studies. 64,113-117”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [113]
The Normal cardiovascular physiology section says cardiovascular events in women increase strikingly with menopause, but it does not identify myocarditis as one of those events. The Sex differences in epidemiology section discusses myocarditis prevalence by sex, not whether women's risk rises after menopause. Page numbers are unavailable in our copy. (LLM, conf=0.80)
Experimental — accuracy not yet measuredPre-COVID myocarditis occurs more often in young men under 50 years, with a sex ratio of 2 to 4:1 men to women.
“Myocarditis pre-COVID is known to occur more often in young men under the age of 50 years, with a sex ratio of 2 to 4:1 men to women”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [113]
The Introduction and Sex differences in epidemiology sections support that myocarditis was more common in men before COVID-19. The epidemiology section gives a male-to-female ratio of 1.5–1.7:1 in recent trials and registries, not 2–4:1; the Historical perspective reports 2.5:1 only for a poliomyelitis outbreak. The cited passages do not establish the under-50 age limit. Page numbers are unavailable in our copy. (LLM, conf=0.88)
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Jain, A., Bruno, K. A., Matsumori, A., Cooper, L. T., Yamani, M., & Fairweather, D. (2022) · Comprehensive Pharmacology · doi:10.1016/b978-0-12-820472-6.00091-8 · Cited by 1 · see citing works
Self-citationStefanska, M., Kot, M., Koterba, D., & Zeyland, J. (2026) · Cells · doi:10.3390/cells15121110
- Authors
- Fairweather, D., Cooper, L. T., & Blauwet, L. A.
- Affiliations
- Johns Hopkins University (US)
- Mayo Clinic (US)
- Corresponding author
- Blauwet, Lori A.
- Venue
- Current Problems in Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-01
- Volume
- 38
- Issue
- 1
- Pages
- 7-46
- ISSN
- 0146-2806 (ISSN-L)
- PMC
- PMC4136454
- OpenAlex
- W2080629518
- Cited by
- 325
- References
- 149
- Citations by year
- 2026: 15 · 2025: 24 · 2024: 21 · 2023: 37 · 2022: 67 · 2021: 39 · 2020: 33 · 2019: 19 · 2018: 14 · 2017: 19 · 2016: 13 · 2015: 6 · 2014: 11 · 2013: 7
- FWCI
- 1.26
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Current Problems in Cardiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute (R01HL087033, R56HL056267, R01HL111938)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Issues in Pregnancy
- Keywords
- sex differences, myocarditis, dilated cardiomyopathy, peripartum cardiomyopathy, sex hormones, innate and adaptive immunity, immune mediators, heart failure, left ventricular function recovery, survival, genetic variation, bromocriptine, women with heart disease
- MeSH terms
- Animals, Cardiomyopathy, Dilated, Female, Humans, Male, Myocarditis, Myocardium, Risk Factors, Sex Factors, Gonadal Steroid Hormones, Ventricular Function, Left, Treatment Outcome, Inflammation Mediators, Genetic Predisposition to Disease, Recovery of Function, Health Status Disparities, Healthcare Disparities
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