AHA Women's Issue Highlights Disparities

Women are underrepresented in clinical trials that are used to formulate guidelines, and lower social support following a heart attack leads to worse outcomes.

A new women-themed issue of the American Heart Association's Circulation: Cardiovascular Quality and Outcomes journal highlights the challenges still present in improving cardiovascular disease outcomes for women. It contains an editorial in which Viola Vaccarino, M.D., Ph.D., argues data on this topic is still limited and has left "more questions than answers," according to AHA.

At the same time, women are underrepresented in clinical trials that are used to formulate guidelines, and their lower social support following a heart attack leads to worse outcomes, according to studies and other contents of the issue.

Vaccarino notes sex-specific research has revealed important differences in the causes, symptoms, and treatment of heart disease, but questions remain about the development, prevention, and treatment of cardiovascular diseases in women. "After at least a decade of renewed interest in women’s cardiovascular health, we are left with more questions than answers," she wrote. Vaccarino is professor of medicine at the Emory University School of Medicine in Atlanta.

AHA says cardiovascular disease is the leading killer of U.S. women, causing more than 430,000 deaths per year.

One study analyzed 156 randomized clinical trials cited by the American Heart Association's 2007 guidelines for cardiovascular disease prevention in women, and it found women were substantially underrepresented, compared with how often they are affected by cardiovascular conditions. Women made up 30 percent of the patient population in the clinical trials used to support the 2007 guidelines, and only about one-third of the 156 trials reported sex-specific results, but at least half of the people who died in the affected patient populations studied were female -- "a proportion that is strikingly higher than their representation in the trials supporting the guidelines — thereby underscoring the importance of having adequate representation of women in clinical trials to solidify the evidence base supporting practice guidelines," the researchers wrote.

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