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Cardiology, still few women in clinical trials

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Cardiology, still few women in clinical trials

On April 19, on the eve of the Day dedicated to Women’s Health, the Monzino Cardiology Center in Milan (Centre of Excellence for Cardiology) dedicates an entire day to the hearts of women. In fact, sex-gender medicine is at the center of the second Monzino Forum on clinical research: an opportunity to take stock of what has been done to fill that gender gap that has always characterized medicine and to understand how much still remains to be done. Do. And there is still a lot left to do.

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Few women in clinical trials

“Reviewing over 20,000 clinical trials conducted between 1993 and 1997, we found a dramatic shortage of female participants and therefore data on women. The situation has not changed over the years: in studies between 2010 and 2017, women were not represented by more than 39% – he recalled Daniela Trabattoni Head, Coronary Interventional Cardiology and Heart Defects Unit and Head of the Monzino Women Heart Center – This means in practice that women are often under-treated because the drugs commonly used for major cardiovascular diseases, starting from heart attacks, are administered in effective doses in men can cause significant side effects in women and consequent poor adherence to therapy. The mechanisms of drug absorption in women may also be different from men; for example, aspirin is eliminated more rapidly from the female body because it has a shorter half-life, while paracetamol is eliminated more slowly”.

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Gender in the doctor-patient relationship

The problem of pharmacological treatments referred to by Trabattoni (who will take part in the first session of the Forum’s work) is but one of the aspects to be considered in sex-gender medicine. When it comes to cardiovascular diseases, in fact, not only are the manifestations of the various pathologies different in the two sexes, but women are also treated less than men or, even, receive the necessary treatments later. Not to mention that even the relationship between doctor and patient can be influenced by sex and gender: a recent review on the topic Nature Review Cardiology, for example, he indicated the male predominance in the cardiology field as a ‘disadvantage’ for female patients, with the risk of greater side effects when specialists are male. Recently, another study has also brought attention to medical devices: too often designed for a standard male patient, with the result that defibrillators, stents, syringes or simple personal protective equipment risk being less effective or simply less fitting in women.

From pacemakers to syringes: sex and gender also make a difference for medical devices by Elisa Manacorda 22 March 2024

The Monzino Forum on clinical research will dedicate sessions to all of this – from pharmacology to medical devices, alongside discussions on how to overcome the gender gap in cardiology. With a clear intent: “It is urgent to revolutionize what the American cardiologist Nanette Wenger called the ‘bikini approach to women’s health‘, focusing on the breasts and reproductive system. Gender medicine is not a one-size-fits-all medicine, but a transversal approach that must take into account biological differences (defined by sex), socio-economic differences (defined by gender) and the specificity of each person”, concludes Trabattoni.

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