Studies Suggest Further Need for Women Leaders in Heart Disease Research & Care

At least three studies that analyzed present trends in funding for cardiology training, leadership, and clinical trials, say that though some progress has been made in narrowing the gender gap favoring men, inequalities persist, and it is associated with the continuing disparities in outcomes for women with heart disease. 

The findings, researchers at Johns Hopkins Medicine say that further document the age-old underrepresentation of women in leadership roles in cardiology despite more women entering medical research and practice. The findings underline the risks of underrepresenting women in clinical research. While heart disease is among the main causes of death among both men and women in the United States, symptoms, treatments, and outcomes of women’s heart disease are often different from those of men. Despite this, women, particularly those in the reproductive stage, are not often recruited for drug trials or any other cardiovascular research. 

Erin Michos, associate professor at the Johns Hopkins University of Medicine and the senior author of the published reports of all the three studies, said,

“Diversity in science is better science. Lack of female leaders in cardiology studies had implications for the professional development of researchers and for the patients they treat.” 

“Having more women in science can bring up issues that are relevant to women,” she says.

“Our studies suggest that promoting women in trial leadership can confront gender bias, improve diversity and inclusivity, and reduce sex and gender-related inequalities in science.” 

A study combining the public database of grant awardees from 2011 and 2020 at the National Institutes of Health (NIH), published in the April issue of the Journal of the American College of Cardiology, showed that 80% of research grants and more funding dollars were allocated to male investigators. Trends showed that over time, more grants are being awarded to women (18 in 2011 versus 47 in 2020), but disparities persist. 

In another analysis exploring authors of studies meant for testing treatments for atrial fibrillation (Afib), published February 22 in the Journal of the American Heart Association, Michos, and her colleagues found that a higher representation of women authors was associated with increased enrollment of women participants. Among 136 trials analyzed between 1985 and 2019, 14% of the authors were women and an average of 35.1% of participants in those trials were women. Michos notes that in general, for every 1% increase in women authors, there was a 19% increase in women enrolled in the Afib trials. 

A third report, published February 25 in JAMA Network Open, examined the gender of authors in pivotal trials supporting the U.S. Food and Drug Administration (FDA) approval of new cardiovascular drugs. From 2008 to 2020, only 10% of authors were women. Women accounted for only 7.5% of first authors and 11.3% of senior authors. 

According to Michos, some aspects of the cardiology culture and climate, and a lack of sponsorship and mentorship, are keeping women away.

“You can’t be what you can’t see, so we need to get to the root of the problem and figure out why talented women medical students and internal medicine residents are not choosing cardiology for their careers,”

she says. 

Some findings of the three studies 

• Between 2011 and 2020, NIH funding for 1,534 R01 grants – fundamental four-year or five-year grants for high-rated independent projects – amounted to $761.4 million (about $2 per person in the US) awarded for cardiovascular research. 
• Women were awarded only 307 of 1,534 grants – about 20%. 
• Overall, the average percentage of women participants in the trials was 35.1%, which did not improve significantly over time. 
• The average number of authors per trial was 10. The average number of women authors per trial was one. 
• Among the 136 trials, 127 had men as first authors (93%) and 125 had men as senior authors (92%). 
• Women comprised 10% of cardiovascular clinical trial leadership.