Amr E. Abbas

Background: This study aimed to evaluate the representation of women in cardiovascular clinical trials referenced in the American College of Cardiology and American Heart Association guidelines, given the historical underrepresentation of women in such trials, which limits generalizability and perpetuates health care disparities. Methods: We conducted a systematic review of studies referenced in American College of Cardiology and American Heart Association guidelines for chronic coronary artery disease, chest pain, and coronary artery revascularization. Data extraction focused on study type, publication year, total study population, and proportion of women enrolled. Participation‐to‐prevalence ratios were calculated to assess gender representation relative to disease prevalence among women in the United States. Results: Our systematic review encompassed 1690 studies revealing persistent underrepresentation of women across all guideline areas: revascularization (29.5%), chronic coronary artery disease (33.3%), and chest pain (40%). Participation‐to‐prevalence ratios ranged from 68.2% to 83.2%, indicating substantial gaps in representation compared with disease burden. Trends over 4 decades showed variability in women's inclusion, with some improvement but minimal overall progress. Conclusion: Despite increased awareness and advocacy, our findings highlight ongoing gender disparities in cardiovascular research. Proactive strategies are needed to enhance women's participation in clinical trials, ensuring equitable and effective health care interventions. Addressing these disparities is critical for developing tailored treatments and improving cardiovascular outcomes globally. Future research should prioritize identifying and overcoming barriers to women's enrollment in cardiovascular trials to promote inclusive clinical practice and mitigate health care disparities.

BACKGROUND: Lower (P =0.024). MG P <0.0001). Severe PPM and MG ≥20 mm Hg were not associated with worse 5-year outcomes compared with none/moderate PPM or MG ≤20 mm Hg, respectively. CONCLUSIONS: Discharge MG 20 mm Hg were not associated with worse 5-year clinical outcomes. Incorporating data on ejection fraction with PPM and MG is important before determining the need for valve optimization.

BACKGROUND: Data comparing valve systems in the valve-in-valve transcatheter aortic valve replacement (TAVR) field have been obtained from retrospective studies. This prespecified secondary analysis of the LYTEN randomized trial (Comparison of the Balloon-Expandable Edwards Valve and Self-Expandable CoreValve Evolut R or Evolut PRO System for the Treatment of Small, Severely Dysfunctional Surgical Aortic Bioprostheses) aims to compare the 3-year hemodynamic performance and clinical outcomes between balloon-expandable valves (BEV) SAPIEN 3/ULTRA (Edwards Lifesciences) and self-expanding valves (SEV) Evolut R/PRO/PRO+ (Medtronic) in valve-in-valve TAVR. METHODS: Patients with a failed small (≤23 mm) surgical valve undergoing valve-in-valve TAVR were randomized to receive a SEV or a BEV. Patients had a clinical and valve hemodynamic (Doppler echocardiography) evaluation at 3-year follow-up. Study outcomes were defined according to VARC (Valve Academic Research Consortium)-2/VARC-3 criteria. Intended performance of the valve was defined as mean gradient P P =0.002), and larger indexed effective orifice area (BEV: 0.69±0.27 versus SEV: 0.93±0.32 cm ² /m ² ; P =0.002). The rate of moderate aortic regurgitation was 0% in the BEV group versus 2.9% in the SEV group ( P =0.582). Functional status and quality of life improved similarly in both groups. No differences were observed in the composite end point of death, stroke, or heart failure–related hospitalization (BEV: 32.6% versus SEV: 25.5%; P =0.489). Mortality was also not statistically different between groups (BEV: 23.3% versus SEV: 15.7%; P =0.375). No significant differences were observed in other adverse events. CONCLUSIONS: In patients undergoing valve-in-valve TAVR for failed small aortic bioprostheses, SEV demonstrated a superior valve hemodynamic performance at 3-year follow-up, with similar clinical outcomes and functional improvement compared with BEV. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03520101.