DEI in Cardiology

Diversity, equity and inclusion (DEI) are key to innovation, but the culture in the cardiovascular medical and research sector is often not supportive of diversity and collaboration.

Novel cardiovascular therapeutics have the potential to improve health outcomes, but financial toxicity from high out-of-pocket costs can limit the reach of these medications and worsen existing health disparities. Understanding the phenomenon of financial toxicity in treating cardiovascular disease is crucial to achieving health equity.

In this Review, Lam and colleagues evaluate the current literature on sex-related differences in treatment responses in patients with heart failure and highlight potential approaches for tailored therapies and the need for sex-specific evaluation of treatment efficacy and safety in future research.

Representation of Black patients in cardiovascular clinical trials remains dismally low, reflective of systemic and structural barriers, which can lead to missed opportunities to meet community-identified needs, understand responses to medical therapies and improve cardiovascular care. Innovative, multilevel strategies focused on Black communities are warranted to increase enrolment of this population into clinical research.

Racial and ethnic disparities in cardiovascular health in the USA result in a persistent mortality gap between white and Black individuals, increase health-care costs and compromise an egalitarian society. Solutions to racial inequities require risk factor control and the implementation of evidence-based medicine and anti-racism policies. Overcoming these disparities is not only a practical necessity, but also a moral imperative.

Low socioeconomic position (SEP) is associated with an increased risk of cardiovascular disease (CVD), but whether this association is causal is uncertain. In this Review, Bann and colleagues discuss how evidence from divergent study designs can help in understanding the causal relationship between SEP and CVD and how this relationship might have been affected by the COVID-19 pandemic.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) has been the focus of an increasing number of studies in the past decade. In this Review, Tavella and colleagues detail the prevalence and clinical presentation of MINOCA, describe the mechanisms underlying the syndrome, and summarize the sex-specific and ethnicity-specific differences in the clinical features, pathophysiological mechanisms, treatment and prognosis of MINOCA.

Establishing and enforcing LGBTQ-inclusive policies at the national, state and institutional level are essential for advancing health equity and ensuring the highest quality cardiology workforce.

Research consistently shows that gender-affirming practices improve markers of cardiovascular health. Consequently, the focus of the management of the cardiovascular health of transgender and non-binary populations should not be on their hormone therapies and surgical histories, but should instead be rooted in the routine screening of cardiovascular risk factors.

Cardiopulmonary resuscitation (CPR) provided by a bystander has saved the lives of many patients with out-of-hospital cardiac arrest. Several factors have been hypothesized to contribute to the low rates of bystander CPR, including the race and/or ethnicity of the recipient and the location of the out-of-hospital cardiac arrest.

Cardiovascular researchers face a range of challenges, including reduced grant funding, job insecurity and a lack of diversity in leadership roles. In this Roadmap article, Marques and colleagues propose strategies to overcome these challenges, focusing on three key areas: capacity building, research funding and fostering diversity and equity.

As a Brazilian female cardiologist who has held leadership positions since my 40s, I understand the difficulties that women face in trying to achieve recognition and senior positions. I believe the awareness and joint efforts of both women and men can help build a more equitable future.

Women who are health providers face unique challenges when building their careers. Despite this, African female cardiologists should have a role in building equitable health systems and minimizing gender disparities in health care by mentoring girls and young women who aspire to a career in medicine and science.

When I have encountered obstacles in the three decades of my career, I have found that self-confidence and courage are the most effective traits for achieving my goals as a female cardiologist.

The proportion of female cardiologists is increasing in China, and they have special roles in clinical management and research. As the president of the Chinese Society of Cardiology, I believe female cardiologists excel in finding ways to balance family life with their career goals when they receive adequate support.

Globally, Black people have some of the highest rates of cardiovascular disease. Racial inequities in cardiovascular health must be tackled. Black In Cardio is a trainee-led initiative aimed at promoting Black people in the cardiovascular field and raising awareness about issues related to the cardiovascular health of Black communities.

Bullying is common in cardiology and can have substantial adverse effects. However, bullying can be addressed by substantive leadership, organizational and individual efforts to build an inclusive and respectful culture.

Childbearing cardiologists face a number of challenges before, during and after pregnancy, including radiation concerns, infertility, pregnancy-related complications, and inadequate parental leave and return-to-work structures. Institutions can promote an equitable work environment by creating policies to mitigate these challenges.

Mentorship is a crucial element to success and satisfaction among medical professionals. For a successful relationship, both mentors and mentees must examine their roles and goals. In this Comment article, a mentor–mentee pair discuss the necessary attributes for a productive partnership.

In this Review, the authors summarize the evidence on the different effects of sex and gender on the pathogenesis, clinical manifestations and treatment responses of patients with ischaemic heart disease or heart failure. In addition, they highlight unexplored areas of sex-related and gender-related factors in cardiovascular disease such as in individuals with gender dysphoria.

A new, very large genome-wide association study has uncovered many novel genetic factors associated with circulating lipid levels. The success of this study came partly from analysing many samples, but mostly from including individuals of non-European ancestry. So, why is studying genetic diversity important and how can it help to fight cardiovascular disease?

In this Review, Essien and colleagues discuss the contributions of social determinants, including race/ethnicity, financial resources, and rural or residential environment, to the evaluation, treatment and management of atrial fibrillation, identify gaps in the literature, and propose future directions to investigate and address social determinants of atrial fibrillation.

Large differences in cardiovascular disease (CVD) morbidity and mortality exist between migrant populations and host populations. Understanding the drivers behind these disparities may help to mitigate the unequal burden of CVD and identify new causal pathways that contribute to CVD risk in the population at large.

The homogeneity of cardiovascular clinical trial populations limits the generalizability of results and compounds health inequities faced by women, older adults and people of colour. This Comment highlights the importance of diversity in clinical trial populations and describes multifaceted interventions that might help to close the diversity gap in trial enrolment.

Burnout is prevalent in medicine and has been further amplified by the COVID-19 pandemic. Strategies must be developed to reduce burnout by addressing a culture of wellness, efficiency of practice, and resiliency. The entire health-care community has a role in addressing burnout and promoting well-being.

Growing evidence indicates that sexual and gender minority populations might be at greater risk of cardiovascular disease than the general population. Additional population and clinical health research is needed to inform the development of tailored, evidence-based interventions to promote the cardiovascular health of sexual and gender minority populations.

The disparities amplified by the COVID-19 pandemic present disturbing evidence that we are far from cardiovascular health-care equity. Individuals, leaders and institutions must prioritize research, policies and structures to advance diversity, equity, inclusion and belonging — Diversity 4.0, a justice imperative, essential to advancing workforce excellence and cardiovascular health.

Social determinants of health in the African diaspora drive the lack of disease testing, increased prevalence of comorbid disease and reduced access to drugs, resulting in disproportionately higher COVID-19-related mortality among Black individuals than the rest of the population. We urge decisive attention to and action against ethnicity-based inequities that undermine cardiovascular health.