AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Sex-Specific Divergence in Alcoholic Cardiomyopathy-Related Mortality Across High-Income Countries, 1990 to 2021
By Shaar MN, Shaar A, Khan W et al.
Background: Alcoholic cardiomyopathy is a preventable cause of heart failure and premature cardiovascular death. Although mortality has declined across many high-income countries, whether these reductions have been equitable by sex remains unclear. We examined national and sex-specific trends in alcoholic cardiomyopathy-related mortality across high-income countries from 1990 to 2021. Methods: We analyzed Global Burden of Disease 2021 estimates of 36 high-income countries classified by the World Bank. Age-standardized alcoholic cardiomyopathy-related death rates per 100,000 were extracted by country, sex, and year. Average annual percentage change (AAPC) was estimated using weighted regression. Countries were ranked and classified into sex-specific trend phenotypes by male and female mortality direction. Results: Overall mortality declined from 1.62 to 1.10 per 100,000 (AAPC –1.48%; 95% CI –1.65 to –1.31; P<0.001). Mortality declined more slowly among males than females: male rates decreased from 2.47 to 2.00 (AAPC –0.97%; 95% CI –1.21 to –0.73; P<0.001), whereas female rates declined more steeply from 0.80 to 0.24 (AAPC –4.05%; 95% CI –4.29 to –3.80; P<0.001). Male mortality remained consistently higher, with a mean absolute male-female gap of 1.96 per 100,000 (95% CI 1.89 to 2.03; P<0.001). National trends were heterogeneous: the largest increases occurred in Greenland and Sweden, while the steepest declines occurred in Argentina and Austria (Figure 1). Worsening trends were predominantly male-driven, with the largest male increases in Greenland, Sweden, Portugal, the United Kingdom, and France (Figure 2). Phenotype analysis identified 13 countries with a discordant pattern of rising male and declining female mortality, including Portugal, the United Kingdom, France, Spain, and Canada, versus only 2 countries where both sexes showed increasing mortality (Figure 3). Conclusions: Aggregate mortality decline masked a widening male-specific cardiovascular mortality gap across high-income countries. The discordant male-rising/female-declining phenotype in 13 countries suggests differential alcohol use disorder burden, delayed male care-seeking, and inadequate addiction-cardiology integration as key drivers. Male-focused alcohol screening, early detection of alcohol-related myocardial dysfunction, and sex-stratified heart failure prevention strategies may be needed in countries with worsening male trends.