Acute and Chronic Myocarditis in Men and Women.

Abstract

Purpose of review: Acute myocarditis (AM) shows sex-specific differences in prevalence, clinical phenotype, and outcomes. This review summarizes evidence from studies published between 2000 and 2026 reporting sex-stratified data on AM epidemiology, presentation, and prognosis to guide future research and a more personalized management.

Recent findings: AM is more frequent in males (54-84%), who present at a younger median age than females (31-35 vs. 38-54 years). This disparity emerges from school age, peaks between 15 and 50 years, and attenuates after menopause, when female incidence increases. Men more often present with chest pain (78-91% vs. 58-78%), ST-segment elevation (35-75% vs. 8-44%), and higher troponin levels. Women more frequently present with dyspnea (29-71% vs. 9-26%), heart failure (11-55% vs. 4-47%), and a prior autoimmune disease (4-25% vs 1-10%). Contemporary registries suggest a worse early course in women, with fulminant presentation in 10-71% vs. 15-17% in men, and in-hospital mortality of 4-8% vs. 2-5%. Conversely, men appear more prone to recurrent myocarditis (3-6% vs. 2-3%). Women are overrepresented in AM associated with desmosomal gene variants (33-69%) and systemic lupus erythematosus (83-91%), whereas men predominate in eosinophilic myocarditis (67-82%) and cardiac sarcoidosis (57-70%). Current evidence supports meaningful sex-related differences in AM prevalence and prognosis, with women appearing to experience a worse early clinical course despite the overall male predominance. Larger dedicated studies are needed to improve sex-tailored risk stratification and management.