Gender differences in cardiology—More questions than answers

The field of cardiology is expanding at an exponential level and keeping track of even the key developments is becoming more and more difficult. It has only been until recently that fundamental concepts of cardiology have been challenged because of a long-neglected fact: the male predominance in cardiovascular research. Many studies forming our modern era understanding of cardiology recruited predominantly men and, more strikingly, the vast majority of first and senior authors have been, and still are, men. Among 403 randomized controlled trials published between the years 2000 and 2019, women represented 15.6% of lead authors, 12.9% of senior authors, and 11.4% of corresponding authors. Of note, the proportion of women as authors remained consistently low between 2000 and 2019 [1]. During the last years, all major cardiovascular research institutions have started programs to address the wide spectrum of gender inequality in clinical and research specialties; however, we still face unanswered questions on a daily basis. Recently, a study on over 1 million patients undergoing surgery reported differences on outcome based on the sex of both the patient and the surgeon. The authors found that female patients were at higher risk for adverse events, including mortality, when surgery was performed by a male surgeon (adjusted odds ratio 1.15, 95% confidence interval, CI 1.10–1.20), whereas male patients treated by female surgeons were at no higher risk (adjusted odds ratio 0.99, 95% CI 0.95–1.03) when compared to the sex concordant patient-surgeon group [2]. Although long known from studies on coronary heart disease [3] and pain management [4], this study should remind us that we have a long way ahead of us to understand key problems in gender-related challenges. …