Is There a Sex Difference in the Prognosis of Hypertrophic Cardiomyopathy? A Systematic Review and Meta‐Analysis

BACKGROUND: It is still unclear whether there is a sex difference in the prognosis of patients with hypertrophic cardiomyopathy (HCM). Therefore, we performed a meta‐analysis to elucidate the association between sex and adverse outcomes in patients with HCM. METHODS AND RESULTS: The PubMed, Cochrane Library, and Embase databases were used to search for studies on sex differences in prognosis in patients with HCM up to August 17, 2021. Summary effect sizes were calculated using a random effects model. The protocol was registered in PROSPERO (International prospective register of systematic reviews) (registration number‐ CRD42021262053). A total of 27 cohorts involving 42 365 patients with HCM were included. Compared with male subjects, female subjects had a higher age at onset (mean difference=5.61 [95% CI, 4.03–7.19]), a higher left ventricular ejection fraction (standard mean difference=0.09 [95% CI, 0.02–0.15]) and a higher left ventricular outflow tract gradient (standard mean difference=0.23 [95% CI, 0.18–0.29]). The results showed that compared with male subjects with HCM, female subjects had higher risks of HCM‐related events (risk ratio [RR]=1.61 [95% CI, 1.33–1.94], I (2)=49%), major cardiovascular events (RR=3.59 [95% CI, 2.26–5.71], I (2)=0%), HCM‐related death (RR=1.57 [95% CI, 1.34–1.82], I (2)=0%), cardiovascular death (RR=1.55 [95% CI, 1.05–2.28], I (2)=58%), noncardiovascular death (RR=1.77 [95% CI, 1.46–2.13], I (2)=0%) and all‐cause mortality (RR=1.43 [95% CI, 1.09–1.87], I (2)=95%), but not atrial fibrillation (RR=1.13 [95% CI, 0.95–1.35], I (2)=5%), ventricular arrhythmia (RR=0.88 [95% CI, 0.71–1.10], I (2)=0%), sudden cardiac death (RR=1.04 [95% CI, 0.75–1.42], I (2)=38%) or composite end point (RR=1.24 [95% CI, 0.96–1.60], I (2)=85%). CONCLUSIONS: Based on current evidence, our results show significant sex‐specific differences in the prognosis of HCM. Future guidelines may emphasize the use of a sex‐specific risk assessment for the diagnosis and management of HCM.