Women with the same cardiovascular conditions and kidney disease as men are less likely to receive active treatment, including surgery, a stent or a strong painkiller, according to a global research review led by the University of St Andrews School of Medicine.
The findings, published in PLOS One, point to a gap between clinical guidance and care in practice. The researchers found that almost none of the studies they examined identified a guideline recommending different treatment according to sex. The review did not establish why treatment decisions differed, or whether clinician judgement, patient preference or institutional factors played a part.
The team sifted 1,112 published studies to identify research that directly compared care for male and female patients. Of the 38 studies that analysed patient records, 33 found a significant difference in the treatment received by men and women. The pattern appeared in cardiology, surgery, transplant medicine and emergency care. In most studies, it remained significant after statistical adjustment for patient characteristics.
For cardiovascular conditions, men with myocardial infarction, heart failure or an irregular heart beat were more likely to receive a coronary bypass, stent or another surgical treatment. Women with those conditions were more likely to receive medication. Women were also less likely to be prescribed statins. Overall, 54% of females compared with 72% of males had started statin treatment within 180 days after myocardial infarction.
The review also identified disparities in kidney care. Women and nonwhite individuals are up to twice as likely to remain undiagnosed as white men for chronic kidney disease. Women are less likely to receive kidney disease testing, specialist referrals and cardiovascular risk management when their clinical results are similar to those of men.
Evidence used to guide treatment is also limited by the representation of women in clinical research. Fewer than 45% of participants in kidney disease trials are women. Women made up about 55% of the global chronic kidney disease population, yet accounted for 45.4% of participants in 192 chronic kidney disease clinical trials published between 1995 and 2022.
Sex-specific reporting was uncommon in those trials. Only 39 of 192 chronic kidney disease trials, just 20%, reported effectiveness outcomes separately for women and men. None of the 192 studies reported adverse events separately by sex.
The available sex-specific results suggest that treatment effects and harms can differ. In the SONAR trial, atrasentan gave women greater kidney protection, while women also had more heart failure events. In the REGENCY trial involving lupus nephritis, women responded substantially better to obinutuzumab, while men achieved better outcomes without treatment.
The St Andrews review found fewer invasive treatments for women in the care examined, but it did not determine whether closing the gap would improve outcomes for women. The researchers' findings identify a recurring difference in care that clinical guidelines rarely appear to direct, alongside gaps in the trial evidence needed to assess treatment benefits and safety separately for women and men.
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