Sex Differences in Infective Endocarditis: A Systematic Review.

Area of Science:

• Cardiovascular Medicine
• Infectious Diseases
• Medical Research Methodology

Background:

• Sex disparities in disease onset, progression, treatment, and outcomes remain poorly understood.
• Infective endocarditis (IE) is a life-threatening condition with reported sex-based differences.
• Existing research suggests potential variations in IE incidence, presentation, and mortality between sexes.

Purpose of the Study:

• To comprehensively evaluate sex disparities in infective endocarditis (IE).
• To analyze differences in incidence, age, comorbidities, etiology, risk factors, manifestations, treatment, and outcomes.
• To identify key areas for future research to address sex-based inequities in IE.

Main Methods:

• Systematic literature search from 2003-2023, identifying 21,584 articles on sex differences in IE.
• Application of PRISMA guidelines to narrow down the selection to 34 relevant publications.
• Comparative analysis of data extracted from the selected studies focusing on sex-specific characteristics.

Main Results:

• Males exhibit higher IE incidence, tend to be older, and have native aortic valve involvement.
• Females present with IE at younger ages, often involving the mitral valve, and have higher rates of culture-negative IE.
• Females experience higher 30-day and 1-year mortality, despite similar in-hospital rates, and often receive more conservative treatment.

Conclusions:

• Significant sex disparities exist in IE incidence, patient demographics, comorbidities, and clinical outcomes.
• Females face increased mortality and potentially delayed or conservative treatment, highlighting healthcare disparities.
• Further research is needed to elucidate the roles of hormones, metabolites, and provider bias in IE sex differences.