The incidence, presentation, clinical features, and evolution of several cardiomyopathies have clear gender-related differences. In general, women show a different response to noxious cardiac agents than men, and they differ in myocardial adaptation to a variety of cardiac insults. Specifically in alcohol-induced heart disease, women have shown different alcohol metabolism features and distinct pathophysiologic mechanisms leading to a higher sensitivity to alcohol-induced heart damage. In preclinical alcohol-induced ventricular dysfunction, women were more sensitive to the toxic effects of ethanol than men. In overt alcoholic cardiomyopathy, women showed about the same prevalence of cardiomyopathy as men, despite having consumed far less ethanol. This supports a greater female propensity to alcohol-induced cardiac damage.