18 February 2025
A new study has confirmed that dilated cardiomyopathy affects twice as many men as women.
The researchers were able to demonstrate that this disparity was partly due to underdiagnosis in women and partly due to a genuine increased risk in males.
Dilated cardiomyopathy (DCM) is a heart muscle disease where the main chamber of the heart becomes enlarged, leading to the heart walls becoming stretched. This makes it harder for the heart to contract properly, making it difficult for blood to be pumped around the body.
The disease affects approximately 1 in 250 people in the UK and increases the risk of heart failure.
The study and its findings
The research team undertook a review of 99 different studies on DCM and found that the condition was twice as common in men. They found that this was true in all types of DCM, as well as DCM due to a genetic cause (monogenic DCM).
The team then looked at data from the UK Biobank study and found that more men were diagnosed with DCM. However, when the team applied sex specific DCM diagnostic criteria (i.e., different cut offs for men and women based on normal ranges in men and women), more women could be diagnosed with DCM.
Putting together these 2 types of study, the team determined that more men being affected by DCM was partly due to underdiagnosis in women but also still a genuine increased risk in men.
Led by Dr Upasana Tayal, consultant cardiologist at Royal Brompton and Harefield hospitals, and clinical senior lecturer at Imperial College London, the study is part of a larger body of work that aims to investigate sex-specific differences in patients with DCM, including this study which found women with DCM develop more complications than men.
Dr Tayal explains the importance of these results:
“For a long time we have been told that DCM affects more men than women. But I couldn’t understand why this would be true in patients with a genetic form of the disease, where we might expect an equally prevalent genetic risk between men and women.
“So my team set out to systematically work out if general DCM and genetic DCM was more common in men or women. To our surprise, we found that genetic DCM was still more common in men, suggesting that either men are more at risk for DCM, men are more likely to be diagnosed, women are protected in some way, or that perhaps women are not being diagnosed.”
Dr Tayal and her team then looked at using sex-based thresholds in those with the genetic form of DCM. She explains:
“In life we have different clothing and shoe sizes for men and women, but in healthcare we don’t often use sex specific cut offs. We found that using sex specific thresholds led to potentially more women being diagnosed with DCM, but really interestingly, it didn’t lead to a 50:50 balance of men and women.”
So what does this mean? Dr Tayal said:
“For me the take aways are that either men are more at risk of DCM or women are at lower risk of DCM, and that we need to work harder and be more vigilant to diagnose DCM in women.”
The team’s next step is to work on understanding why DCM and other cardiomyopathies affect men and women differently, so they can improve how patients living with these conditions are cared for.
You can view the research publication here. You can also listen to a podcast with Dr Payal where she discusses the project.
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