Impact of female underrepresentation in trials investigating long-term pharmacologic therapy after acute coronary syndrome: a meta-analysis and meta-regression
Pooled result · Sex difference in the relative effect measure (REM; mostly a hazard ratio) for the primary efficacy endpointMean difference in the log of the REM 0.00 95% CI −0.05-0.05- meta-analysis and meta-regression
- systematic search of Embase, Medline Ovid, and Cochrane Central
- random-effects meta-analysis
- Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines
+3 more
- systematic search of Embase, Medline Ovid, and Cochrane Central
- random-effects meta-analysis
- Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines
Authors' conclusion
In RCTs of long-term pharmacological therapy after ACS, treatment efficacy was comparable between sexes, irrespective of sex distribution. These findings support current guidelines recommending equivalent long-term pharmacological strategies for secondary prevention in both sexes.
Study context
- Population
- Randomized controlled trials comparing long-term pharmacological therapy for acute coronary syndromes (ACS) with placebo or standard care, with ≥1-year follow-up and a clinical event as the primary outcomeRandomized controlled trials (RCTs), 48 trials provided sex-stratified data
- Participants
- 102 participants
- Comparison
- Sex differences in treatment effects
- Outcome
- Sex difference in the relative effect measure (REM; mostly a hazard ratio) for the primary efficacy endpoint
Pooled result
As reported in the abstract
Sex difference in the relative effect measure (REM; mostly a hazard ratio) for the primary efficacy endpoint
Mean difference in the log of the relative effect measure (REM)
0.00
95% CI −0.05-0.05
P = 0.98
males vs females
mean difference in the log of the REM 0.00 (95% CI −0.05-0.05); P = 0.98
Further pooled results
Female representation in trials
- Female representation range
- 10 to 52%
Relationship between female trial participation and sex-specific treatment effects (meta-regression)
- No relationship between female trial participation and sex-specific treatment effects
Original publication
Impact of female underrepresentation in trials investigating long-term pharmacologic therapy after acute coronary syndrome: a meta-analysis and meta-regression. Eur Heart J Acute Cardiovasc Care. Published 4 February 2026. doi:10.1093/ehjacc/zuag020
Summarised from the published abstract; every number is checked against it