Issue highlights:

  • An analysis of data from ClinicalTrials.gov, one of the largest trial registries in the world, found that women represented less than 40% of the people enrolled in heart disease and stroke clinical research.
  • Reviews on the number of women choosing to study and treat heart disease and stroke — and those who are being chosen to publish the research that could save lives of the next generation of women — show that the gender gap remains wide in academia.
  • These studies and more are highlighted in a special February 2020 issue of Circulation, its annual Go Red for Women® special edition, which features several new studies, research letters and professional perspectives on the unique challenges that women face in their battle against heart disease and stroke.

Embargoed until 1 p.m. CT/2 p.m. ET, Monday, February 17, 2020

DALLAS, Feb. 17, 2020 — Cardiovascular disease is the No. 1 killer of women worldwide, yet women continue to be grossly underrepresented in heart disease and stroke research, in research publishing roles and even in the medical practice of cardiology, according to data published today in Circulation, the flagship journal of the American Heart Association.

For the fourth year in a row, the editors of Circulation have published a special February issue focusing on the unique challenges that women face in their fight against heart disease and stroke. This year’s issue launches the journal’s new Science Goes Red™ collection, a collaboration with Go Red for Women®, the global movement to end heart disease and stroke in women from the American Heart Association.

This issue features more than a dozen manuscripts, including peer-reviewed full papers, research letters, clinical and professional perspectives, editorials and feature interviews.

“One woman dies from cardiovascular disease every 80 seconds. It’s the leading killer of all women around the globe, claiming the lives of one in every three women, yet disparities continue to persist when it comes to symptom recognition, treatment times and methodologies, and even lifesaving support measures,” said Editor-in-Chief of Circulation Joseph A. Hill, M.D., Ph.D.,  FAHA, chief of cardiology at the University of Texas Southwestern Medical Center in Dallas. “We are pleased to highlight some of the best cardiovascular science focusing on women, and we maintain an ongoing commitment to move the field forward, working with investigators and clinicians around the world to eliminate disparities for women in health care and within the biomedical workforce.”

Lack of knowledge is often cited as a reason for these disparities, as women have historically been underrepresented in cardiovascular research. This trend continues — an analysis of cardiovascular research data found that women comprised less than 40% of all people enrolled in cardiovascular clinical trials between 2010-2017.

Researchers examined 740 completed cardiovascular clinical trials reported between January 1, 2010 and December 31, 2017 on ClinicalTrials.gov, one of the largest and longest running trial registries in the world, a resource provided by the U.S. National Library of Medicine and managed by the National Institutes of Health. Of the 862,652 adults in the trials, the average age of trial participants of both sexes was 60.8 years, ranging from 25 to 89 years.

Researchers found:

  • Only 38% of all trial participants were women.
  • The highest proportion of women (53.8%) were represented in trials sponsored by research institutes.
  • Trials solely sponsored by government (excluding the National Institutes of Health) had the lowest proportion of women participants (15.9%) compared with other sponsors, probably because most of these were sponsored by the Veteran Affairs Office of Research and Development. 
  • Pulmonary hypertension studies had the highest proportion of women participants (76.3%), while acute coronary syndrome had the lowest (26.9%).
  • A higher percentage of women age 55 or younger participated in trials (50.3%), whereas those age 61-65 were least represented (26%).
  • Device, procedure and medication trials had lower representation by women than lifestyle trials.

Study authors argued that several effective strategies are needed to include more women in cardiovascular research; however, until that happens, health care providers should be mindful of gender differences in disease diagnosis, manifestation treatment and prognosis.

The American Heart Association's Go Red for Women® movement and Verily's ProjectBaseline have joined forces to launch Research Goes Red™, an initiative calling on women across the United States to contribute to and participate in health research. Women can learn more and get involved at projectbaseline.com/gored.

Publishing clinical research results in peer-reviewed scientific journals is an important capstone, yet a review in this issue of Circulation found that not only are women underrepresented in the research, they’re also underrepresented among the editorial boards of those journals.

Researchers set out to determine the current status of women on journal editorial boards by looking at the January 2018 mastheads of general cardiology journals from the U.S. (Circulation, Journal of the American College of Cardiology, Journal of the American Medical Association Cardiology and American Journal of Cardiology) and the 2019 mastheads for general cardiology journals from Europe (Heart, International Journal of Cardiology and European Heart Journal). They also reviewed information on more than a dozen subspecialty journals, including four from Circulation — Cardiovascular Imaging, Cardiovascular Interventions, Heart Failure and Arrhythmia and Electrophysiology. They compared trends over the past 20 years and found:

  • Between 1998 and 2018, there were no women editors-in-chief in U.S. general cardiology journals and there was only one female editor-in-chief in a general European cardiology journal.
  • Among all subspecialty journals, only the American Heart Association’s Circulation: Heart Failure had a female editor-in-chief.
  • Though there were only two women editors-in-chief over the initial 20 years reviewed, the American Heart Association’s Circulation Research and two new Journal of the American College of Cardiology journals (CardioOncology and Case Reports) all named women editors-in-chief for 2019.
  • Women were less represented among deputy/associate editors in European general cardiology journals (9%), compared with U.S general cardiology journals (20.7%), although editorial board membership was similar (11.8% vs. 12.8%, respectively).
  • Over 20 years, women deputy/associate editors’ representation increased significantly in Circulation, and women editorial board membership increased for Circulation and Journal of the American College of Cardiology, without a significant change in the American Journal of Cardiology.
  • Women serving on the editorial boards of all three major U.S. cardiovascular journals combined doubled over the decade (6.3% to 12.9%), yet absolute representation for women remained low.

The authors said their study highlights the need for continued attention to barriers in career advancement for women in cardiology. “Engagement of women faculty at early career stages as ad hoc reviewers would help create a robust pipeline of future women editors. Diversity in editorial boards can not only improve the societal relevance and quality of the journal, but also provides women role models for future generations. A more gender-balanced and diverse editorial team adds value by decreasing publication bias against women, providing a favorable impression of the journal and increasing likelihood of competitive submissions,” they concluded in their review.

Gender disparities in heart disease and stroke aren’t limited to how they are studied, diagnosed or treated, they also exist when it comes to who is doing the research and providing the health care, according to a research letter in this special issue of Circulation.

The 2017-2018 report of the Association of American Medical Colleges showed women made up less than a fourth (21.4%) of all adult cardiology trainees, only a modest increase from a decade ago (15.9%).

A review of the Accreditation Council for Graduate Medical Education-accredited training program data found that cardiology ranked second for the most underrepresented specialty of women (21%), preceded only by orthopedic surgery (15.3%), with obstetrics/gynecology having the highest representation of women trainees (83%).

The researchers said their finding show that marked gender disparity still prevails for training within the cardiology field and its subspecialties, with little change occurring over the past decade, highlighting the importance of appropriate measures to achieve higher gender equity and focused follow-up evaluations of effectiveness.

Other studies within this special issue of Circulation evaluate the link between breast cancer and heart disease; the unique risk factors women face that make a one-size-fits-all heart disease risk stratification obsolete; the invaluable collaboration of cardiologists and OB/GYNs in assessing gender-specific risks; a paper associating increased body mass index in young women with increased risk of subsequent cardiomyopathy; and more.

Learn more on women and heart disease at Go Red for Women.org.

Additional Resources:

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at https://www.heart.org/en/about-us/aha-financial-information.

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

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For Media Inquiries and AHA/ASA Expert Perspective: 214-706-1173

Cathy Lewis: 214-706-1324; cathy.lewis@heart.org

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