Female Representation in the Antiplatelet Medication Literature Informing the 2023 Canadian Antiplatelet Guidelines

Area of Science:

• Cardiology
• Clinical Trials
• Health Equity

Background:

• Antiplatelet medications are crucial for managing atherosclerotic cardiovascular disease.
• The 2023 Canadian Antiplatelet Guidelines rely on existing literature for recommendations.
• Assessing female representation in this literature is vital for guideline accuracy.

Purpose of the Study:

• To evaluate the adequacy of female participant representation in randomized controlled trials (RCTs) informing the 2023 Canadian Antiplatelet Guidelines.
• To identify potential biases in evidence used for cardiovascular disease treatment recommendations.

Main Methods:

• Systematic review of literature cited in the 2023 Canadian Antiplatelet Guidelines.
• Inclusion of only RCTs, excluding observational studies, reviews, and guidelines.
• Extraction of data on sample size, participant age, and proportion of female participants.

Main Results:

• 109 RCTs were included, totaling 570,217 participants (mean age 65.4 years).
• The mean percentage of female participants across trials was only 28.5%.
• Nearly two-thirds of the evidence informing the guidelines demonstrated inadequate female representation.

Conclusions:

• The evidence base for the 2023 Canadian Antiplatelet Guidelines is largely informed by trials with insufficient female representation.
• There is a critical need to improve the inclusion of female patients in antiplatelet medication clinical trials.
• Enhanced female representation in research is essential for developing equitable and effective clinical guidelines.