Women and elderly: subgroups under-represented in clinical trials.
OBJECTIVE
Women and older patients with cardiovascular disease are frequently underinvestigated and are less likely to receive evidence-based treatments than younger male counterparts. A lack of sex and age-specific clinical trial evidence is frequently cited for this practice. This manuscript reviews the currently available evidence base in the management of both groups presenting with ischaemic heart disease and heart failure.


RESULTS
Registry data in both women and older patients confirm that these groups receive suboptimal care in the management of ischaemic heart disease and heart failure. A number of recent trials, including several meta-analyses, do not support this practice and suggest that, with the possible exception of implantable cardiac defibrillator implantation in females, both women and elderly patients derive similar benefit to younger males in the management of risk factors, symptomatic ischaemic heart disease and heart failure.


CONCLUSIONS
Pending sex and age-specific trials to address in particular not only outcomes but dosing and complications, women and elderly patients should receive similar evidence-based treatment of cardiac risk factors, symptomatic ischaemic disease and heart failure to younger males.
Devlin
Gerard
G
University of Auckland Waikato Hospital, Hamilton, New Zealand. devling@waikatodhb.govt.nz
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D035843:Biomedical Research / Q000379:methods*; D002986:Clinical Trials as Topic / Q000379:methods*; D017147:Defibrillators, Implantable; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006333:Heart Failure; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia; D005791:Patient Care; D012307:Risk Factors; D016387:Women's Health