Background: Sarcoidosis is a chronic, non-necrotizing granulomatous disorder of unknown etiology, with cardiac involvement accounting for 25% of all sarcoidosis cases. Cardiac sarcoidosis has been reported to occur more frequently in men, but women tend to experience more frequent hospitalizations and better outcomes. It is important to explore this disparity to help improve patient care.

Objectives: This observational, retrospective cohort study aims to explore gender disparities in cardiovascular outcomes among patients with sarcoid myocarditis. We utilized the TrinetX database, which included electronic health records from 142 different global healthcare organizations.

Methods: We studied patients aged 18 years and above diagnosed with sarcoid myocarditis using International Classification of Diseases, Tenth Revision (ICD-10) codes. The index event was the diagnosis of sarcoid myocarditis. Two cohorts were created: cohort 1 included 4,092 female patients and cohort 2 included 5,360 male patients with sarcoid myocarditis. We employed propensity score matching for age at the time of the index event, race/ethnicity, comorbidities (diabetes mellitus, hyperlipidemia, hypertension, chronic kidney disease (CKD), tobacco use, chronic rheumatic heart disease, acute rheumatic fever, sarcoidosis of lung, overweight and obesity), medications (aspirin, statins, methotrexate, azathioprine, mycophenolate mofetil, and rituximab) resulting in 3,338 patients in each cohort. Our outcomes of interest included mortality, sudden cardiac death (SCD), major adverse cardiovascular events (MACE), heart failure, atrial fibrillation, ventricular fibrillation, conduction heart disease, pacemaker insertion, stroke, and Tumor Necrosis Factor-alpha (TNF-α) inhibitors use after index event. Patients experiencing these outcomes before the index event were excluded. Measures of association, Kaplan-Meier survival analysis, and risk ratio calculations were used.

Results: Before propensity matching, the female cohort was noted to have higher rates of diabetes (24.6% versus (vs) 22.4%), obesity (30.3% vs 22.4%), and methotrexate use (13.7% vs 9.8%), while males had more CKD (17.1 vs 14.2%) and amiodarone use (12.7% vs 7.3%). After matching, these disparities were largely mitigated. Our study demonstrated that the female cohort had lower mortality (7.6% vs. 9.7%, RR 0.787, 95% CI 0.673–0.921, p = 0.003), lower incidence of MACE (26.8% vs. 30.2%, RR 0.887, 95% CI 0.798–0.986, p = 0.026) and heart failure (25.0% vs 29.0%, RR 0.862, 95% CI 0.775-0.959, p = 0.006) compared to males. The risk for ventricular fibrillation (2.03% vs. 3.5%, RR 0.575, 95% CI 0.427–0.776, p < 0.001) and atrial fibrillation (11.0% vs. 13.0%, RR 0.843, 95% CI 0.731–0.972, p = 0.019) were also lower in the female cohort. However, the use of TNF-α inhibitors was similar in both groups. There was no statistically significant difference in sudden cardiac death, stroke, heart block, or pacemaker insertion rates between the groups.

Conclusion: Our study suggests that females with sarcoid myocarditis have a lower risk of mortality, major cardiovascular events, heart failure, and arrhythmias. Additional research is needed to explore the underlying mechanisms that could contribute to the gender disparities in sarcoid myocarditis outcomes.

REFERENCES: NIL.

Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.