Stable or not, woman or man: is there a difference?

In 2010 a dedicated group of researchers interested in women’s hearts, gathered in Brussels for a workshop discussing gender differences in cardiovascular disease (CVD). The workshop was undertaken as a result of an earlier report the same year from the European Heart Health Strategy (Euro-Heart) project showing that women are still under-represented in many cardiovascular clinical trials. Fewer women than men have been included in cardiovascular trials and, consequently, the evidence base is less firm for women regarding several treatments. The mean percentage of women enrolled in cardiovascular clinical trials since 2006 was 30%, while only 50% of trials reported results by gender analysis. Fewer evidence-based preventive, diagnostic, and therapeutic options for women with CVD may lead to undertreatment and a lower quality of care in comparison with men. Prospective studies to elucidate whether there are true differences in the effects of different treatment strategies according to gender and outcome are greatly needed to identify the most appropriate treatment for men and women, respectively (Table 1). The CLARIFY population has now been analysed from a gender perspective. The CLARIFY, being a prospective, observational, longitudinal registry of patients with stable coronary artery disease consisting of .33 000 patients in 45 countries worldwide, has the potential to fill in some of the gaps called for in the Red Alert for Women’s Heart, workshop. Indeed this is a very good attempt to straighten out some unclarified fields in the cardiovascular area. What is the new knowledge from this analysis? It is a well-known fact that co-morbidities, risk factors, medication, management, and sometimes, but not always, outcome differ. –8 The authors claim that this as a large contemporary cohort of outpatients with stable coronary artery disease (CAD), and broad geographic representation provides new information. It may well be so, but some issues have to be taken into consideration and merit some further attention.