Women Making Strides as First Authors of Cardiology Trials

The number of women appearing as first authors of cardiology trials has increased over the last decade from 22% to 30%, according to a new analysis. The relatively low proportion, however, speaks to the larger problem of underrepresentation in this medical specialty, its authors conclude.

The paper was published a research letter today in JAMA Network Open.

“What you're seeing here is shedding light on the fact that while there is some progress, it's still slower than what we would like to see in cardiology,” lead author Roxana Mehran, MD (Icahn School of Medicine at Mount Sinai, New York, NY),  told TCTMD. “Hopefully more women will be attracted to the field, seeing that there is progress and that the important academic contributions of women in cardiology, while small in numbers, are making a large impact in both scientific and clinical work.”

Senior author Ankur Kalra, MD (Cleveland Clinic, OH), added: “The good news is that there appears to be more diversity in women first authors than men. If you parse the data . . . you see repetition of the same man being a first author, whereas with women you see more diversity [in terms of] positioning on the paper and other women on the paper.” The implication is that women are more likely than men to share lead author positions with their female colleagues, he explained.

Commenting on the findings for TCTMD, Harriette Van Spall, MD, MPH (McMaster University, Hamilton, Canada), said contemporary analyses have typically found the number of women as first authors of cardiology trials to be much lower than 30%. In one analysis of over 400 heart failure trials, for example, her group found that women accounted for only 16% of first authors, 13% of senior authors, and 11% of corresponding authors.

Mehran and colleagues used the term “cardiology” in their database search of female authors. Use of such a broad term and their look beyond high-impact journals may be why they found more women than other analyses had previously.

Still, Van Spall said the study elevates the discussion about women’s underrepresentation in clinical cardiology trials and what is required to close the gap.

“Equal opportunity is a human right that doesn't require justification. Every woman, person of color, older person, younger person—everyone should have equal opportunity—and success should be determined by merit and ability versus your demographic,” she added. “There are many things in our work environment that give opportunity disproportionately to some over others.”

Women Face a Steeper Climb

Data from the American College of Cardiology (ACC) Women in Cardiology Leadership Council show that only 12% of cardiologists are women, with the proportion as low as 9% among interventional cardiologists. To look at the percentage of female first authors in cardiology RCTs, Mehran and colleagues examined data from 6,189 trials published between 2011 and 2020.

Of the 30% of first authors who were women, 43% had distinctive first names. In comparison, only 27% of male first authors had distinctive first names. According to Mehran and colleagues, this “is indicative of greater diversity among female first authors.”

To TCTMD, Kalra said efforts by the Society for Cardiovascular Angiography and Intervention’s Women in Innovations program and the ACC’s Women in Cardiology Member Section and Leadership Council, among others, have likely helped to shed light on the lack of women in prominent research positions in cardiology.

The gaps we see in clinical cardiology are widened in clinical research, and it's partly because of the uneven playing field that we all are embedded in. Harriet Van Spall

“Words matter and these initiatives matter, because they put a spotlight on something that has been a blind spot in our field for years,” he commented.

Van Spall said it’s also important to understand the reasons why having more women lead clinical trials makes a difference. For one thing, data show that it can increase the number of female patients who enroll.

“We do know that first principle investigators and global PIs that are women work very hard towards that goal to make sure that their trials have good representation of women and underrepresented minorities,” Mehran agreed.

Secondly, being prominently associated with RCTs increases the visibility of women role models and serves as encouragement for female trainees that trials are not only the domain of men. Van Spall said women-led trials promote research into issues of importance to female patients while also increasing representation and diversity at decision-making tables for policy and implementation.

“The gaps we see in clinical cardiology are widened in clinical research, and it's partly because of the uneven playing field that we all are embedded in,” Van Spall said. The climb is steeper and the journey harder and the commitment required much greater.”

As Van Spall’s research has shown, women are more than twice as likely to be first authors of a clinical trial if the senior author also is a woman. Those data make clear the importance of encouraging research training for early-career cardiologists, as well as joining research networks and enrolling in registries that offer research collaboration, she said. Senior researchers can help through mentoring and including more women in their research networks.

“There are some definitive actions that we all must take so that we transition from talking about a gap to fixing it,” Van Spall noted.

Mehran noted that while most of her mentors were men, things are changing thanks in part to work being done by societies like the ACC, American Heart Association, and the European Society of Cardiology to promote diversity and inclusion in the field.

“Today we're seeing a fantastic opportunity for women to be mentored by some of the great ones, men and women. We are also engaging many male mentors to begin looking for talented women and helping to elevate them and promote them to where they deserve to be in our field,” she said. “I see a silver lining in all of the pain that we've all felt over the years of noninclusivity. There is more and more awareness. There's more and more understanding of how important it is to be trained in unconscious bias, and to look diligently at the talented women who are right there under your nose and begin to promote them and give them the opportunities. It’s happening slowly, and cardiology is a good place for women to be in 2021.”