Heart Device Studies Leave Women Behind
Despite FDA requirements, few heart device trials address gender, report says.
March 2, 2011— -- Cardiovascular device development remains skewed against women, with too few trials adequately addressing gender despite long-standing requirements by the FDA, researchers found.
The proportion of women in trials for devices that made it onto the market persisted at about one-third from 2000 through 2007, Dr. Rita F. Redberg of the University of California San Francisco and colleagues reported in the March issue of Circulation: Cardiovascular Quality and Outcomes.
While only 41 percent of studies reviewed by the FDA for approval made some mention of gender bias, 26 percent of those that did identified some difference in safety or effectiveness by sex, supporting the importance of such analyses, Redberg's group noted.
The incomplete safety and efficacy data for women "may mean that more women are experiencing adverse events for a device lacking a mortality benefit," the researchers warned.
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They pointed to implantable cardioverter-defibrillator registry data showing higher likelihood of in-hospital and major adverse events compared with men but no mortality benefit in primary prevention for women with heart failure to compensate.
The justifications given for the failure to adequately address gender just perpetuate the status quo, Redberg's group added.
For example, they noted one heart failure study that enrolled only 22 percent of women despite equal representation of women among Medicare patients with impaired left ventricular function, which gave as the explanation that these demographics were typical for a U.S. device trial.
"There is no question that women continue to be underrepresented in clinical trials," said Dr. Michelle O'Donoghue, an investigator in the TIMI study group in the cardiovascular division of Brigham and Women's Hospital. "This is true despite the fact that cardiovascular disease remains the leading cause of death in women in the United States."
Despite the discrepancy, O'Donoghue said it's unclear why female participation lags behind men. It is not known if women are approached less frequently than men or women are less willing to participate.
The National Institutes of Health and the FDA have been calling for inclusion of women in trials since the mid-'80s, including a specific directive from the FDA in 1994 requiring that device approval applications address the ratio of men and women in the studies and differences in safety and effectiveness by gender.
The researchers systematically reviewed all 78 such data summaries released to the public for class III cardiovascular devices approved from 2000 through 2007.
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