Sex related differences in acute and recurrent pericarditis: A narrative review.

Background: Acute and recurrent pericarditis represent significant clinical challenges, with growing evidence suggesting important sex-related differences in their presentation, etiology, and course. This review synthesizes current knowledge on these disparities. Methods: Given the heterogeneity of available evidence and the limited number of studies with sex-specific analyses, this review was conducted in a narrative format. Discussion: While acute pericarditis is more prevalent in men, particularly at a younger age and often due to idiopathic or viral causes, women are more frequently affected at an older age and similarly mostly due to viral or idiopathic causes; however, women exhibit a stronger association with autoimmune etiologies compared to men. The clinical presentation also diverges, with men more often presenting with classic features like chest pain, pericardial rub, and characteristic electrocardiographic changes, whereas women may present with atypical features. A critical finding is that women face a higher burden of recurrent pericarditis, experiencing more frequent and severe episodes, which may be linked to their higher prevalence of autoimmune conditions and the subsequent greater use of corticosteroid therapy, which is a known risk factor for recurrence. Conclusion: Distinct sex-related patterns in acute and recurrent pericarditis necessitate a more tailored diagnostic and therapeutic approach. Further large-scale studies are warranted to definitively establish the links between sex hormones, autoimmune predisposition, and treatment outcomes to optimize patient care for both men and women.