Women in cardiology leadership of randomized clinical trials and participation of women in late-breaking clinical trials: has the COVID-19 pandemic changed a thing or not exactly?

Introduction

Despite considerable developments made in the representation of women in cardiology (WIC) recently, there still remain substantial disparities in the representation of women participants in clinical trials, as well as women physicians and scientists in clinical trial leadership. Under-representation of women in Randomized Clinical Trials (RCTs) remains the bane of the modern medicine, impeding the development of sex-specific guidelines in cardiovascular diseases. Female leadership in clinical trials has been shown to enhance the inclusion of women as trial participants. Furthermore, while the COVID-19 pandemic has impacted women in academia, there is no data thus far reporting the impact of the pandemic in terms of presenters and leadership of late-breaking clinical trials (LBCT) in cardiology during this period.

Purpose

We aimed to determine inclusion of WIC in LBCTs leadership and their correlation to inclusion of women in reported RCTs.

Methods

In our comprehensive analysis, we included all LBCTs presented at major international cardiovascular meetings reported over the period of January 2020 to February 2022. Data were derived from the original presentation at the meeting and/or simultaneous/ subsequent publication of manuscript. Sex of the presenter (woman or man), was assessed by either original videos of the presentation at the meeting, or based on pronoun use in the biographies derived from institutional profiles. The presence or absence of reporting of sex distribution of study participants were also recorded from original presentation at the meeting and/or published manuscript. Proportion of women included in each trial was sourced from either original publication or calculated from any similar data shown during the presentations.

Results

A total of 400 of RCTs from 19 meetings were included with a total of 400 presenters/principal investigators recorded – 32 (8%) women and 368 (92%) men. There were no significant differences between 2020 and 2021 [15 (7.2%) women in 2021 vs. 17 (19.3%) in 2020 (P=0.446)]. Proportions of women included in RCTs with WIC (37.3%) vs. non-WIC (38.7%) presenters were comparable (p=0.559), while 45% of RCTs didn't report sex distribution of participants. Except for 2 meetings (CRT 2020 and 2022), all others were virtual.

Conclusion

WIC representation as RCTs presenters was significantly low, despite the opportunity of virtual attendance afforded during the COVID-19 pandemic. Modest inclusion of women irrespective of sex of RCT leadership emphasizes multi-level problems that require more actionable solutions: i.e. implicit bias training started as early as medical school, continuing education on necessity for diversity, equity and inclusion, patient and public involvement, and comprehensive guidance on trial design, such that future RCT participants reflect the populations intended to treat.

Funding Acknowledgement

Type of funding sources: None.

P5345Association and prevalence of post-stroke erectile dysfunction with cardiovascular risk factors and co-morbidities

Objectives

The aim of this study was to establish a correlation between prevalence and severity of erectile dysfunction (ED) and cardiovascular (CV) co-morbidities and ongoing medication and other risk factors associated with post-stroke ED.

Materials and methods

For 153 patients (57.04±6.54 years) with ischemic stroke, we evaluated the pre- and post-stroke prevalence of ED using the five-item International Index of Erectile Function questionnaire (IIEF5).

Erectile Function questionnaire (IIEF5). Within 5 days of admission we determined the stroke site location and severity using the National Institute of Health Stroke Scale (NIHSS). The pre- and post-stroke data obtained were compared with those of 30 control non-stroke patients (52.27±8.35). Additional cardiovascular co-morbidities, medication and risk factors were asset and analyzed.

Results

The IIEF5 scores were much lower [median 17 interquartile range (IQR) 10–20] post stroke than pre-stroke (median 22 IQR 12–23) and lower than in control group (median 22.5 IQR 21–24).

From the analysis of comorbidities and risk factors for stroke of post- stroke group and the control group, we infer that diabetes (p=0.003), hypercholesterolemia (p<0.001), and hypertension (p<0.001) were more common in patients with stroke than those in the control group. (Table 1).

From the statistical analysis of data on medication use by patients, results that more patients have used ACE inhibitors, calcium antagonists, beta blocking agents, diuretics, statins, oral agents, antiplatelet and oral anticoagulants after the stoke than before, and in terms of consumption of drugs before stroke compared with the control group, differences were not significant.

Lot 1 Lot 2 Lot 3 P values P values P values post-stoke patients pre-stroke patients control group [1 vs 3] [2 vs 3] [1 vs 2] No. of Patients 153 153 30 Age, mean ± SD 57.04±6.54 57.04±6.54 52.27±8.35 Pacient with ED, N (%) 127 (83%) 76 (49.67%) 9 (30%) <0.001 0.048 <0.001 Severity of ED, N (%)   Mild 74 (48.37%) 29 (18.95%) 7 (23.33%) 0.015 0.581 <0.001   Mild to moderate 1 (0.01%) 11 (7.19%) 1 (3.33%) 0.302* 0.694* 0.127*   Moderate 28 (18.30%) 21 (13.73%) 1 (3.33%) 0.052* 0.134* <0.001*   Severe 24 (15.69%) 15 (9.80%) 0 0.016* 0.136* <0.001* IIEF5 (Erectile function)   Mean ± SD 15.53±5.89 17.83±6.18 21.83±3.31 <0.001 <0.001 <0.001   Median (Q1–Q3) 17 (10–20) 22 (12–23) 22.5 (21–24) Hamilton Score   Normal 91 (59.4%) 144 (94.1%) 23 (76.6%)   Mild depression 40 (26.1%) 1 (0.6%) 5 (16.6%)   Moderate depression 11 (7.1%) 0 (0.0%) 1 (3.3%)   Severe depression 9 (5.8%) 6 (3.9%) 1 (3.3%)   Very severe depression 2 (1.3%) 2 (1.3%) 0 (0.0%) Comorbidities   Diabetes mellitus 59 (38.5%) 3 (10.0%) 0.003*   Hypercholesterolemia 104 (67.9%) 6 (20.0%) <0.001   Hypertension 121 (79.0%) 8 (26.6%) <0.001   Obesity 36 (23.5%) 6 (20.0%) 0.674   Smoking 53 (34.6%) 5 (16.6%) 0.056*   Atrial fibrillation 22 (14.3%) 2 (6.6%) 0.377*   Carotid artery stenosis 18 (11.7%) 1 (3.3%) 0.321*   Coronary hearth disease 26 (16.9%) 1 (3.3%) 0.086* Medication   ACE inhibitors 72 (47.0%) 32 (20.9%) 2 (6.6%) <0.001* 0.075* <0.001   Calcium Antagonists 49 (32.0%) 17 (11.1%) 4 (13.3%) 0.047* 0.755* <0.001   Beta-Blokers 65 (42.4%) 36 (23.5%) 3 (10.0%) 0.001* 0.142* <0.001   Diuretics 43 (28.1%) 14 (9.1%) 3 (10.0%) 0.039* >0.999* <0.001   Statins 99 (64.7%) 25 (16.3%) 4 (13.3%) <0.001* 0.791* <0.001   Oral antidiabetics 39 (25.4%) 25 (16.3%) 1 (10.0%) 0.007* 0.084* 0.442   Insulin 20 (13.0%) 15 (9.8%) 0 (0.0%) 0.048* 0.136* 0.369   Antiplatelet drugs 131 (85.6%) 14 (9.1%) 2 (6.6%) <0.001* >0.999* <0.001   Oral anticoagulants 22 (14.3%) 8 (5.2%) 0 (0.0%) 0.028* 0.357* 0.007   Antidepressants 28 (18.3%) 12 (7.84%) 2 (6.6%) 0.176* >0.999* 0.007

Conclusions

The prevalence and severity of ED increase after stroke due to disruption of autonomous central structures. The depression, functional impairment, CV co-morbidities and medication used after stroke may contribute to ED.

Morphological aspects in a urogenital malformation, complex and rare, in a child

The aim of this study follows the detailed evolution of a child diagnosed with prune-belly syndrome. This syndrome is a complex dysplasia, a rare pathology in children, characterized by the triad--the classic--hypo- or aplasia of righteous abdominal, cryptorchidism, abnormality of the urinary tract; also, it can be associated with pulmonary, cardiac, digestive, osteoarticular, and other malformations. Diagnostic criteria and etiopathogeny aspects are presented showing embryopathy and X-linked hereditary transmission theories as the most plausible, as proofed by recent genetic studies. Analyzing therapeutic aspects, it is stressed that medical treatment precedes or follows surgery, which cannot resolve urinary infection unless dysplastic urinary reconstruction is performed. Serious forms of prune-belly syndrome have a development and poor prognosis. Intrauterine and neonatal mortality is 20% and 50% in the first two years of life. The risk of urinary infection and/or lungs burdens the patient's clinical condition, allowing further appreciation on evolution of the disease. For cases solvable by plastic surgical reconstruction, as those who respond to medical therapy, differentiation will be monitored in territory and check-ups by the specialized consulting room from Polyclinic Health Center. Urinary infection relapse danger is permanent, requiring differentiated supervision. These case interest practitioners, by at least two aspects: the rarity of the disease, and complexity of dysplasia constituent, which has serious implications on the body economy.