Acute and Chronic Myocarditis in Men and Women

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%). Summary 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.