Rising heart failure in women due to disparities in clinical trials

On February 2, 2024, a special publication by the American College of Cardiology revealed its concerns about the rising rate of heart failure (HF) in women as part of its renewed commitment to alleviating inequitable differences in cardiac care. 

Heart disease remains the leading cause of death globally and in 2021 resulted in about 700,000 deaths in the United States. 

Over the last few years, Dr. Jessica Schultz and Dr. Bhavadharini Ramu found that “the incidence of HF is increasing more in women than in men, especially among racial and ethnic minorities.”

This is particularly worrying due to new concerns over the similar ways in which men and women are treated for heart conditions, despite the biological differences that complicate treatments.

Dr. Schultz noted how, when evaluating men and women treated with the same HF medication, “Women have been shown to have up to 2.5-times higher plasma concentrations.”

The implications of this are that when women are given the standard dose of a medication, they are more likely to suffer from dangerous or unusual side effects as well as potentially lower efficacy of treatment. 

This disparity often results from the lack of women in clinical trials, as women are only “accounting for approximately 20-25% of study participants.”

As women are significantly outnumbered by men in clinical studies, new medications are developed without proper consideration of the differences in how women metabolize and react to different medications—not to mention the different ways in which heart disease manifests itself in women as opposed to men. 

In response, the American College of Cardiology issued a call to all cardiologists to recognize and take action on this issue.

Dr. Schultz and Dr. Ramu believe that “an intentional multifaceted approach” is necessary.

It should incorporate targeting gender-specific differences in prevention, ensuring adequate access to management regimens, and finally, “the enrollment of women in adequate numbers in HF clinical trials.”

To improve the quality of treatment of HF in the future, it is necessary to take action and make these changes “to balance the scales in sex disparities in HF.”