Hypertrophic cardiomyopathy has long been studied as a condition affecting both sexes equally at the genetic level — yet the clinical reality for women is markedly worse. A growing body of evidence now confirms that this gap is not random variation but a reproducible pattern with structural causes, raising urgent questions about how cardiology assesses, refers, and treats half its HCM population.
This review in Current Cardiology Reports synthesizes contemporary data on sex-based disparities across the full arc of HCM — from initial presentation through long-term management. Women receive their HCM diagnosis at a later stage than men, arriving with more pronounced left ventricular outflow tract obstruction, more severe diastolic dysfunction, and a heavier heart failure burden at the time of first evaluation. Crucially, despite carrying ventricular arrhythmia and sudden cardiac death risks comparable to men, women progress to advanced heart failure more frequently and report significantly lower quality of life. The review also highlights that existing sex-neutral risk stratification models may systematically underestimate disease severity in women — a calibration problem with direct clinical consequences. On the therapeutic side, cardiac myosin inhibitors, a newer pharmacological class targeting the sarcomere, appear to deliver similar or potentially greater symptomatic benefit in women.
This review lands at a moment when sex-disaggregated analysis is reshaping cardiovascular medicine broadly. HCM is particularly vulnerable to diagnostic delay in women because its symptoms — exertional dyspnea, fatigue, atypical chest discomfort — overlap heavily with anxiety and deconditioning, conditions women are more often assumed to have. The persistent underrepresentation of women in HCM clinical trials compounds the problem: risk models trained predominantly on male cohorts carry embedded bias. From a longevity standpoint, late-stage heart failure carries substantially higher five-year mortality than earlier-stage disease, meaning diagnostic delays translate directly into lifespan consequences. This is a confirmatory and synthesizing review rather than a paradigm-shifting primary study, but its clinical implications are immediate and actionable at the systems level.