Transthyretin amyloid cardiomyopathy (ATTR‑CM)* is a progressive, unrelenting disease that can diminish quality of life, cause recurrent hospitalization, and lead to premature death.1–3

*Also known as ATTR cardiomyopathy, or ATTR cardiac amyloidosis (ATTR‑CA).

There are two subtypes of ATTR‑CM: wild-type ATTR‑CM (wtATTR‑CM) and hereditary ATTR‑CM (hATTR‑CM).*,4 These subtypes are designated by the mechanism of TTR tetramer destabilization, which occurs either through age-related changes to the protein or due to variants in the TTR gene.4

*Also known as variant ATTR‑CM (vATTR‑CM).

80% of patients


Wild-type ATTR-CM4,10,12

  • Sporadic disease
  • TTR gene has normal sequence; TTR protein becomes unstable with age
  • Reduced symptom severity at diagnosis
  • Typically manifests later in life (>60 years of age)

Variant ATTR-CM1,12,13

  • Autosomal dominant pattern of inheritance
  • TTR gene has variant sequence that destabilizes the TTR protein
  • Worse disease at diagnosis (poorer ejection fraction, renal function, and performance status)
  • Symptom onset at 30–80 years of age

In a study of 879 people with ATTR-CM.11

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A prevalent pathogenic TTR gene variant is V122I, which affects 3–4% of all Black Americans and has been found in 10% of those aged 65 years or older with severe congestive heart failure14

Although predominantly diagnosed in men, ATTR‑CM is becoming increasingly recognized in women15

sex differences in attr-cm infographic

*In a study of 1732 consecutive patients, comprising 1095 with wild-type ATTR‑CM and 637 with hereditary ATTR‑CM.15

On average, women are 3.3 years older than men at diagnosis.15

Both sexes have similar mortality rates, 1-year disease progression rates, and overall structure and function when accounting for body size.15


Lane T, et al. Natural History, Quality of Life, and Outcome in Cardiac Transthyretin Amyloidosis. Circulation. 2019;140(1):16-26. 2. Rintell D, et al. Patient and Family Experience with Transthyretin Amyloid Cardiomyopathy (ATTR-CM) and Polyneuropathy (ATTR-PN) Amyloidosis: Results of Two Focus Groups. Orphanet J Rare Dis. 2021;16(1):70. 3. Nativi-Nicolau J, et al. Natural History and Progression of Transthyretin Amyloid Cardiomyopathy: Insights from ATTR-ACT. ESC Heart Fail. 2021;8(5):3875-3884. 4. Rozenbaum MH, et al. Impact of Delayed Diagnosis and Misdiagnosis for Patients with Transthyretin Amyloid Cardiomyopathy (ATTR-CM): A Targeted Literature Review. Cardiol Ther. 2021;10(1):141-159. 5. Gillmore JD, et al. Nonbiopsy Diagnosis of Cardiac Transthyretin Amyloidosis. Circulation. 2016;133(24):2404-12. 6. Kittleson MM, et al. American Heart Association Heart Failure and Transplantation Committee of the Council on Clinical Cardiology. Cardiac Amyloidosis: Evolving Diagnosis and Management: A Scientific Statement From the American Heart Association. Circulation. 2020;142(1):e7-e22. 7. Griffin JM, et al. ATTR Amyloidosis: Current and Emerging Management Strategies: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol. 2021;3(4):488-505. 8. Witteles RM, et al. Screening for Transthyretin Amyloid Cardiomyopathy in Everyday Practice. JACC Heart Fail. 2019;7(8):709-716. 9. Gertz M, et al. Avoiding Misdiagnosis: Expert Consensus Recommendations for the Suspicion and Diagnosis of Transthyretin Amyloidosis for the General Practitioner. BMC Fam Pract. 2020;21(1):198. 10. Reynolds MM, et al. Ocular Manifestations of Familial Transthyretin Amyloidosis. Am J Ophthalmol. 2017;183:156-162. 11. Law S, et al. Characteristics and Natural History of Early-Stage Cardiac Transthyretin Amyloidosis. Eur Heart J. 2022;43(27):2622-2632. 12. Ruberg FL, et al. Transthyretin Amyloid Cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019;73(22):2872-2891. 13. Michels da Silva D, et al. Inflammatory and Molecular Pathways in Heart Failure-Ischemia, HFpEF and Transthyretin Cardiac Amyloidosis. Int J Mol Sci. 2019;20(9):2322. 14. Buxbaum JN, Ruberg FL. Transthyretin V122I (pV142I)* Cardiac Amyloidosis: An Age-Dependent Autosomal Dominant Cardiomyopathy Too Common to Be Overlooked as a Cause of Significant Heart Disease in Elderly African Americans. Genet Med. 2017;19(7):733-742. 15. Patel RK, et al. Sex Differences Among Patients With Transthyretin Amyloid Cardiomyopathy – From Diagnosis to Prognosis. Eur J Heart Fail. 2022;24(12):2355-2363.