Ten years ago, a review in the journal Public Health set out an agenda for public health research in heart failure by identifying six areas where major gaps remained in knowledge (at that time).1 One of the six issues was titled “Are women getting a fair deal?”, calling attention to how research into cardiovascular diseases was noteworthy for the extent to which women were under-represented or excluded. The authors attributed this situation to an underlying belief that cardiovascular disease is primarily a male problem.

This belief was in fact a prejudice resulting from the confusion between absolute and relative measures! It is true that the incidence of cardiovascular diseases, particularly coronary heart disease and heart failure, is higher in men, particularly at younger ages. However, they are still a major cause of death and disability among women, more frequent than breast cancer and other diseases seen as major problems of women’s health.

Is there gender bias in heart failure?

There certainly is gender bias in recruitment to randomised studies of the efficacy of interventions in heart failure, both pharmacological therapy and devices and surgical therapy. In large part this bias is related to the fact that left ventricular systolic dysfunction is often …