Sex Differences in Presentation and Outcomes of Transthyretin Amyloid Cardiomyopathy

doi:10.1016/j.jacadv.2026.103068

Sex Differences in Presentation and Outcomes of Transthyretin Amyloid Cardiomyopathy

JACC AdvPublished 28 Jul 2026Consecutive prospective patients with confirmed ATTR-CM enrolled in the multicenter Swiss-CARE registry

Main finding · First MACE (composite of heart failure hospitalization and all-cause mortality)ResultHazard ratio 1.86 95% CI 1.13–3.04

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Authors' conclusion

Women exhibited a higher risk of MACE after diagnosis; however, sex was not an independent predictor of outcomes in multivariable analysis. This disadvantage in women may be partly explained by older age at diagnosis, higher NT-proBNP levels, greater symptom burden, and a higher prevalence of comorbidities, rather than intrinsic sex-specific differences in ATTR-CM progression.

Study context

Population: Patients with confirmed transthyretin amyloid cardiomyopathy (ATTR-CM), Swiss-CARE registry, February 2018-March 202552 [9%] women
Participants: 567 patients

Exposure: Women vs men with ATTR-CM
Womenn = 52
Outcome: First MACE:
Composite of heart failure hospitalization
All-cause mortality

Main finding

As reported in the abstract

First MACE:

Composite of heart failure hospitalization
All-cause mortality

Hazard ratio

1.86

95% CI 1.13–3.04

P = 0.014

Women vs Men

HR 1.86 (95% CI 1.13–3.04); P = 0.014

Observational data: associations, not effects.

Further findings

Age at diagnosis · women older

P < 0.001

Womenmean 80.3 yearsSD 6.1

Menmean 76.9 yearsSD 6.9

N-terminal pro-B-type natriuretic peptide · higher in women

P = 0.006

Women2,574 pg/mL

Men1,632 pg/mL

6-minute walking distance · shorter in women

P = 0.001

Womenmean 320 mSD 111

Menmean 411 mSD 114

Tafamidis prescription · less frequent in women

P = 0.004

Women50.0%

Men69.7%

Outcome	← Lower risk with women ←→ Higher risk with women →	HR (95% CI)	P value
Heart failure hospitalizations · within the first 2 years	0.20.5125	2.21 (1.17–4.19)	P = 0.015
All-cause mortality · trend	0.20.5125	1.82 (0.97–3.43)	P = 0.06
	0.20.5125Hazard ratio (log scale)

Outcome	Estimate	P value
NYHA functional class · higher in women		P < 0.001

Original publication

Sex Differences in Presentation and Outcomes of Transthyretin Amyloid Cardiomyopathy. JACC Adv. Published 28 July 2026. doi:10.1016/j.jacadv.2026.103068

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Summarised from the published abstract; every number is checked against it