Gaps in epidemiology of cardiovascular diseases

The present issue of the journal is focused on some gaps in the epidemiology of cardiovascular diseases (CVDs), involving insufficient understanding of sex/gender differences, under-representation of women and minorities in research, and failures in translating knowledge into equitable practice, especially regarding social/environmental factors and emerging risks (like inflammation). Filling these gaps is a priority for healthcare management.1 Female patients with acute myocardial infarction are at higher risk of presenting heart failure (HF) symptoms at the hospital admission and of developing HF during hospitalization. A prospective, multi-centre registry across six teaching hospitals in Spain showed that among 1279 patients, women more commonly presented HF symptoms than men (23.9 vs. 17.4%, P < 0.001).2 Female patients, together with older individuals, are under-represented in randomized clinical trials. The BRING-UP-3 HF study was a prospective, observational, multi-centre investigation encompassing 179 Italian cardiology sites, which involved 5203 HF patients and confirmed the presence of these gaps: female patients were older and were less likely to receive optimal medical therapies (OMTs) compared with males. Similarly, older patients also experienced suboptimal treatment. After multivariable adjustment, age remained independently associated with a lower likelihood of receiving OMT. Tailored management strategies are needed to optimize medical therapy for females and older adults, to improve HF outcomes and ensure equitable care.3