August 12, 2026Journal of the American College of Cardiology438 citationsOpen Access
Gender-Related Differences in the Clinical Presentation and Outcome of Hypertrophic Cardiomyopathy
Key Result
Female gender was associated with an increased risk of symptom progression to NYHA class III/IV or death from heart failure or stroke compared with male gender (HR 1.5; p<0.001).
Key Points
- This research aims to evaluate how gender affects the clinical presentation and outcomes of hypertrophic cardiomyopathy (HCM).
- Studied 969 consecutive HCM patients from Italy and the U.S. over a follow-up of 6.2 years.
- Compared demographics, symptoms, and clinical outcomes based on gender.
- Female patients were older and more symptomatic (47 years vs. 38 years; p < 0.001).
- Left ventricular outflow obstruction occurred more frequently in females (37% vs. 23%; p < 0.001).
- Women at greater risk for symptom progression or death (independent relative hazard 1.5; p < 0.001).
Study Design
Type
Cohort (n=969)
Multicenter
Yes
Structured PICO
Does female gender increase the risk of adverse clinical outcomes in patients with hypertrophic cardiomyopathy?
P
Population
969 consecutive patients with hypertrophic cardiomyopathy from Italy and the U.S., followed for a mean of 6.2 years.
E
Exposure
Female gender
C
Comparator
Male gender
O
Outcome
Symptom progression to NYHA functional classes III/IV or death from heart failure or strokecomposite
Women with hypertrophic cardiomyopathy present at an older age, are more symptomatic, and have a higher risk of progression to advanced heart failure or death compared to men.
Main Result
Hazard Ratio: 1.5
p-value: p=<0.001
Abstract
OBJECTIVES: The goal of this study was to assess gender-related differences in a multicenter population with hypertrophic cardiomyopathy (HCM). BACKGROUND: Little is known regarding the impact of gender on the heterogeneous clinical profile and clinical course of HCM. METHODS: We studied 969 consecutive HCM patients from Italy and the U.S. followed over 6.2 +/- 6.1 years. RESULTS: Male patients had a 3:2 predominance (59%), similar in Italy and the U.S. (p = 0.24). At initial evaluation, female patients were older and more symptomatic than male patients (47 +/- 23 years vs. 38 +/- 18 years; p or =50 years of age and with resting outflow obstruction (p < 0.005). Hypertrophic cardiomyopathy-related mortality and risk of sudden death were similar in men and women. CONCLUSIONS: Women with HCM were under-represented, older, and more symptomatic than men, and showed higher risk of progression to advanced heart failure or death, often associated with outflow obstruction. These gender-specific differences suggest that social, endocrine, or genetic factors may affect the diagnosis and clinical course of HCM. A heightened suspicion for HCM in women may allow for timely implementation of treatment strategies, including relief of obstruction and prevention of sudden death or stroke.
Expert Takes2 quotes
1/2
“Women often tell me, 'I've been dealing with these symptoms all this time and I can't tell you how many doctors have made me feel like I was out of my mind, made it up, or it's actually anxiety.' Yet no one assessed these women for potential cardiac conditions like HCM.”
Anjali Owens, Medical Director, Center for Inherited Cardiac Disease, University of PennsylvaniaUniversity of Pennsylvaniaauto_pipelineCautiousView source