Heart failure & cardiomyopathies
Systematic Review, Meta-Analysis, and Population Study to Determine the Biologic Sex Ratio in Dilated Cardiomyopathy
Authors' conclusion
This study demonstrates that DCM is twice as prevalent in male patients. This was partially mitigated by implementing sex-specific DCM diagnostic criteria. The persistent male excess in genotype-positive patients with an equally prevalent genetic risk suggests additional genetic or environmental drivers for sex-biased penetrance.
Study context
- Population
- Adult dilated cardiomyopathy (DCM) patient cohorts (n≥100; excluding pediatric and peripartum)
- Participants
- 37,525 participants · 99 studies
- Comparison
- Female proportion in DCM overall vs genetic subtypes
- Outcome
- Proportion of female participants (sex ratio) in DCM, by genetic status
Methodological detailsmetaregression, UK Biobank imaging cohort
- Metaregression
- UK Biobank imaging cohort
Pooled result
As reported in the abstract
Female proportion
| Group | Value | M:F | P vs overall |
|---|---|---|---|
| Overall DCM | 0.30 (95% CI 0.28–0.32) | 2.38:1 | |
| Identified DCM variant | 0.31 (95% CI 0.26–0.36) | 2.22:1 | P=0.56 |
| Gene-elusive DCM | 0.30 (95% CI 0.24–0.37) | 2.29:1 | P=0.81 |
| TTN | 0.28 (95% CI 0.22–0.36) | 2.51:1 | P=0.82 |
| LMNA | 0.35 (95% CI 0.27–0.44) | 1.84:1 | P=0.41 |
| Autosomal dominant gene variants | 0.34 (95% CI 0.28–0.40) | 1.98:1 | P=0.19 |
Value
Overall DCM0.30 (95% CI 0.28–0.32)
Identified DCM variant0.31 (95% CI 0.26–0.36)
Gene-elusive DCM0.30 (95% CI 0.24–0.37)
TTN0.28 (95% CI 0.22–0.36)
LMNA0.35 (95% CI 0.27–0.44)
Autosomal dominant gene variants0.34 (95% CI 0.28–0.40)
M:F
Overall DCM2.38:1
Identified DCM variant2.22:1
Gene-elusive DCM2.29:1
TTN2.51:1
LMNA1.84:1
Autosomal dominant gene variants1.98:1
P vs overall
Overall DCMNot reported in the abstract
Identified DCM variantP=0.56
Gene-elusive DCMP=0.81
TTNP=0.82
LMNAP=0.41
Autosomal dominant gene variantsP=0.19
Further pooled results
Population DCM M:F ratio by diagnostic approach (UK Biobank, n=47 549)
- ICD-10 coding
- 4.5:1
- Sex-specific imaging-first
- 1.7:1
- Genotype-first
- 2.3:1
Original publication
Systematic Review, Meta-Analysis, and Population Study to Determine the Biologic Sex Ratio in Dilated Cardiomyopathy. Circulation. Published 3 February 2025. doi:10.
Summarised from the published abstract; every number is checked against it