The DOI matches its Crossref record; 330 of the 333 references it cites were found in a registry or an index, and 1 are not checked yet.
Sex and gender differences in myocarditis and dilated cardiomyopathy: An update
Open accessAbstract
In the past decade there has been a growing interest in understanding sex and gender differences in myocarditis and dilated cardiomyopathy (DCM), and the purpose of this review is to provide an update on this topic including epidemiology, pathogenesis and clinical presentation, diagnosis and management. Recently, many clinical studies have been conducted examining sex differences in myocarditis. Studies consistently report that myocarditis occurs more often in men than women with a sex ratio ranging from 1:2–4 female to male. Studies reveal that DCM also has a sex ratio of around 1:3 women to men and this is also true for familial/genetic forms of DCM. Animal models have demonstrated that DCM develops after myocarditis in susceptible mouse strains and evidence exists for this progress clinically as well. A consistent finding is that myocarditis occurs primarily in men under 50 years of age, but in women after age 50 or post-menopause. In contrast, DCM typically occurs after age 50, although the age that post-myocarditis DCM occurs has not been investigated. In a small study, more men with myocarditis presented with symptoms of chest pain while women presented with dyspnea. Men with myocarditis have been found to have higher levels of heart failure biomarkers soluble ST2, creatine kinase, myoglobin and T helper 17-associated cytokines while women develop a better regulatory immune response. Studies of the pathogenesis of disease have found that Toll-like receptor (TLR)2 and TLR4 signaling pathways play a central role in increasing inflammation during myocarditis and in promoting remodeling and fibrosis that leads to DCM, and all of these pathways are elevated in males. Management of myocarditis follows heart failure guidelines and there are currently no disease-specific therapies. Research on standard heart failure medications reveal important sex differences. Overall, many advances in our understanding of the effect of biologic sex on myocarditis and DCM have occurred over the past decade, but many gaps in our understanding remain. A better understanding of sex and gender effects are needed to develop disease-targeted and individualized medicine approaches in the future.
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In the citing paper
“Few females progress to DCM in humans or autoimmune/viral myocarditis animal models. 64,124”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [64]
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Importantly, the findings highlight that myocarditis occurs predominantly in male patients aged 12 to 40 years regardless of whether the cause was due to a virus-like SARS-CoV-2 or associated with a vaccine-a demographic that has been reported before COVID-19.”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [64]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“We have published previously that upregulation of complement and TLRs including TLR4 are key immune pathways that promote myocarditis in the autoimmune-CVB3 animal model”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [64]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Myocarditis typically occurs more often in young men aged 16 to 30 years, and the sex ratio for COVID-19 studies is typically observed to be 60% men to 40% women.”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [64]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“with men developing more scar tissue and dilated cardiomyopathy (DCM) than women. 64,124,131”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [64]
Experimental — accuracy not yet measured
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In the citing paper
“suggesting potential alternative pathogenesis such as autoimmunity, hypersensitivity, or medication usage.”
From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [150]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Notably, in some cases of lymphocytic myocarditis, these viruses tested negative, while autoantibodies specific to the heart were present”
From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [150]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Myocarditis is a well-known disease presenting sex differences, with males showing a higher prevalence and mortality rate, observed in both human and animal models. 150”
From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [150]
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In the citing paper
“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 [64]
The cited source says what the claim attributes to it.
In the citing paper
“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 [64]
The cited source says what the claim attributes to it.
In the citing paper
“Proposed mechanisms include more proinflammatory and profibrotic immune profiles in the heart of males compared with females, potentially attributed to differences in sex hormones. 150”
From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [150]
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Similar to myocarditis, preCOVID pericarditis occurs more often in young men under the age of 50 years with a sex ratio of around 2:1. 64,95,118”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [64]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“The accuracy of cMRI depends on the amount of scar tissue present”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [64]
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Citations
Cites
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Flagged first, then by citations
2 of the 333 references couldn’t be matched to a known paper.
Research works printed but not linked: 4
- 2015, Consideration of Sex as a Biological Variable in NIH-funded Research.
- 2022, Sex/Gender-Specific COVID-19 Outcomes and Management Relevant for Heart, Lung, Blood, and Sleep Disorders: From Bench to Bedside.
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Metadata
- Authors
- Fairweather, D., Beetler, D. J., Musigk, N., Heidecker, B., Lyle, M. A., Cooper, L. T., & Bruno, K. A.
- Affiliations
- Mayo Clinic (US)
- Humboldt-Universität zu Berlin (DE)
- Corresponding author
- Fairweather, DeLisa
- ORCID
- Venue
- Frontiers in Cardiovascular Medicine
- Publisher
- Frontiers Media SA
- Published
- 2023-03-02
- Volume
- 10
- Pages
- 1129348-1129348
- ISSN
- 2297-055X (ISSN-L)
- PMC
- PMC10017519
- OpenAlex
- W4322773336
- Cited by
- 124
- References
- 333
- Citations by year
- 2026: 29 · 2025: 32 · 2024: 44 · 2023: 19
- FWCI
- 6.60
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Cardiovascular Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institutes of Health (R01 HL164520, R21 AI145356, R21 AI152318, R21 AI154927, TL1 TR002380, R21 AI163302, R01 HL135165)
- American Heart Association (20TPA35490415)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Viral Infections and Immunology Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
- Keywords
- sex differences, gender differences, myocarditis, dilated cardiomyopathy, sex ratio, postmenopausal women, heart failure biomarkers, soluble ST2, Toll-like receptor signaling, cardiac remodeling, heart failure treatment, personalized medicine
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