SynthesisJournal of the American Heart Association2026
Closing the Gap: Examining Representation of Women in Ischemic Heart Disease Guideline Studies.
Synthesis in Journal of the American Heart Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
15 authors.
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Abstract
backgroundThis study aimed to evaluate the representation of women in cardiovascular clinical trials referenced in the American College of Cardiology and American Heart Association guidelines, given the historical underrepresentation of women in such trials, which limits generalizability and perpetuates health care disparities.
methodsWe conducted a systematic review of studies referenced in American College of Cardiology and American Heart Association guidelines for chronic coronary artery disease, chest pain, and coronary artery revascularization. Data extraction focused on study type, publication year, total study population, and proportion of women enrolled. Participation-to-prevalence ratios were calculated to assess gender representation relative to disease prevalence among women in the United States.
resultsOur systematic review encompassed 1690 studies revealing persistent underrepresentation of women across all guideline areas: revascularization (29.5%), chronic coronary artery disease (33.3%), and chest pain (40%). Participation-to-prevalence ratios ranged from 68.2% to 83.2%, indicating substantial gaps in representation compared with disease burden. Trends over 4 decades showed variability in women's inclusion, with some improvement but minimal overall progress.
conclusionDespite increased awareness and advocacy, our findings highlight ongoing gender disparities in cardiovascular research. Proactive strategies are needed to enhance women's participation in clinical trials, ensuring equitable and effective health care interventions. Addressing these disparities is critical for developing tailored treatments and improving cardiovascular outcomes globally. Future research should prioritize identifying and overcoming barriers to women's enrollment in cardiovascular trials to promote inclusive clinical practice and mitigate health care disparities.
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