Cited by 125Viral Infections and Immunology ResearchCardiac Fibrosis and RemodelingCardiomyopathy and Myosin Studies

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

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Abstract

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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Crossref · 10.3389/fcvm.2023.1129348

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FIGURE 1 Sex differences in the pathogenesis of viral myocarditis and DCM. The summary of mechanisms of sex differences are primarily based on the Fairweather model of viral myocarditis (see text for full description). DCM, dilated cardiomyopathy; E2, estrogen/17β-estradiol; ♀, female; IFN, interferon; IL, interleukin; ♂, male; Te, testosterone; Th, T helper cells; TLR, Toll-like receptor.
FIGURE 1 Sex differences in the pathogenesis of viral myocarditis and DCM. The summary of mechanisms of sex differences are primarily based on the Fairweather model of viral myocarditis (see text for full description). DCM, dilated cardiomyopathy; E2, estrogen/17β-estradiol; ♀, female; IFN, interferon; IL, interleukin; ♂, male; Te, testosterone; Th, T helper cells; TLR, Toll-like receptor.CC BY · PubMed Central

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Cites

Research works printed but not linked: 4

  1. 2015, Consideration of Sex as a Biological Variable in NIH-funded Research.
  2. 2022, Sex/Gender-Specific COVID-19 Outcomes and Management Relevant for Heart, Lung, Blood, and Sleep Disorders: From Bench to Bedside.
  3. 2012, What a Difference Sex and Gender Make: A Gender, Sex and Health Research Casebook.
  4. Nakaya, 2003, Estrogenic compounds suppressed interferon-gamma production in mouse splenocytes through direct cell-cell interaction., In Vitro Cell Dev Biol Anim., 39, 383, 10.1290/1543-706X(2003)039<0383:ECSIPI>2.0.CO;2 · DOI

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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
Venue
Frontiers in Cardiovascular Medicine
Published
2023-03-02
Volume
10
Pages
1129348-1129348
ISSN
2297-055X (ISSN-L)
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
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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