Sex-Related Differences in Dilated Cardiomyopathy with a Focus on Cardiac Dysfunction in Oncology

Abstract

Purpose of Review The aim of this report is to describe the main aspects of sex-related differences in non-ischemic dilated cardiomyopathies (DCM), focusing on chemotherapy-induced heart failure (HF) and investigating the possible therapeutic implications and clinical management applications in the era of personalized medicine. Recent Findings In cardio-oncology, molecular and multimodality imaging studies confirm that sex differences do exist, affecting the therapeutic cardioprotective strategies and, therefore, the long-term outcomes. Interestingly, compelling evidences suggest that sex-specific characteristics in drug toxicity might predict differences in the therapeutic response, most likely due to the tangled interplay between cancer and HF, which probably share common underlying mechanisms. Summary Cardiovascular diseases show many sex-related differences in prevalence, etiology, phenotype expression, and outcomes. Complex molecular mechanisms underlie this diverse pathological manifestations, from sex-determined differential gene expression to sex hormone interaction with their receptors in the heart. Non-ischemic DCM is an umbrella definition that incorporates several etiologies, including chemotherapy-induced cardiomyopathies. The role of sex as a risk factor for cardiotoxicity is poorly explored. However, understanding the various features of disease manifestation and outcomes is of paramount importance for a prompt and tailored evaluation.

Cardio-Oncology: A Myriad of Relationships Between Cardiovascular Disease and Cancer

“…The cardiotoxicity produced by different drugs differed concerning age and gender ( Table 2 ). Sex-related genes are also involved in regulating the development of chemotherapy-related cardiac insufficiency ( 139 ). However, there are few studies related to the effect of gender on the efficacy and complications of antitumor therapy, and more gender- and age-specific studies are needed in the future to clarify the effectiveness of antitumor therapy and provide more theoretical support for clinical use.…”

Genetic Basis of Dilated Cardiomyopathy in Dogs and Its Potential as a Bidirectional Model

“…In humans, despite having an inheritance pattern of autosomal dominant in most familial DCM cases, males are significantly more often affected than females with a reported prevalence of about 60% [69]. Recent studies have documented that women have a better long term prognosis than males [70], clinical signs occur significantly earlier in males than in females [71], and that males have a greater prevalence of clinical signs and a higher mortality rate than females [72,73].…”