Medicine and equal opportunities, an increasingly topical duo

Antonio Landi, PhD assistant at the Faculty of Biomedical Sciences and winner of USI Equal Opportunities Award 2024 for scientific contributions on topics of equality and diversity, presented his research to us, providing a comprehensive examination of gender medicine.

Antonio Landi, could you please explain the research you conducted and the results it led to?

"The study, published in JAMA Cardiology, aimed to analyse the impact of gender on optimal drug therapy in patients with coronary atherosclerotic disease undergoing angioplasty with coronary stent placement. In these patients, current guidelines recommend dual anti-platelet therapy (DAPT) for a total duration of 6 or 12 months in patients with chronic and acute coronary syndrome, respectively, to reduce the risk of ischaemic complications during follow-up. Extending the duration of DAPT beyond 6-12 months provides, on the one hand, greater protection from potential ischaemic adverse events (e.g. myocardial infarction) but is associated, on the other hand, with an increased risk of bleeding. The impact of gender on the risk of bleeding remains controversial, as some studies have shown that women are at a higher risk of bleeding, while others have shown no significant differences. To answer these questions, we performed our study as part of the MASTER DAPT clinical trial with two main objectives: to analyse the clinical events after coronary angioplasty in male and female patients at high risk of bleeding, and to evaluate the effects of a reduced duration of DAPT compared to standard therapy in both sexes. Our results indicate that a shortened DAPT may be the preferred strategy for women at high risk of bleeding undergoing coronary angioplasty. They may benefit from it in terms of bleeding (comparably to men), without a potential increase in ischaemic events compared to conventional drug treatment."

How much attention does gender medicine, a concept also introduced by the World Health Organization (WHO), receive in our region nowadays?

"I believe that gender medicine has become increasingly important in recent years. In the field of cardiology, it is particularly relevant, as more than seven and a half million women die of cardiovascular diseases every year. Research such as the study we conducted can help raise awareness that therapies can be specific to gender, making them more targeted. The data from our studies indicates significant differences based on gender. These variances include not only the pathophysiological mechanisms of diseases, but also how patients respond to drug therapy. While gender medicine was once considered a niche field, it is now becoming increasingly relevant. This trend is consistent throughout the Western world.

What is the scope for development of your study?

"Based on our study results, we found that approximately 30% of the included patients were women. We then analysed a screening log of the MASTER DAPT, which reported all patients undergoing coronary angioplasty for 14 consecutive days in selected centres. The purpose of this analysis was to determine if a larger proportion of women were excluded from the study, which women were not considered for the study, and what reasons were provided by the researchers for their exclusion. The interesting aspect we highlighted was that a higher number of women were either not offered participation in the study or declined participation. The main reason reported for this was the investigators' belief that there was a high risk of adverse events for women. This indicates that women are less frequently offered the opportunity to participate in clinical trials due to the investigators' perception of a high risk for women. This is often referred to as "gender bias". These findings demonstrate that there are still obstacles to women's involvement in clinical trials, particularly in studies related to cardiovascular diseases, and that more efforts are necessary to promote their greater participation."

If you could implement one change to create more equality in medicine, what would it be?

"The first thing that comes to mind is to develop studies that can focus exclusively on women. Continuing to design and conduct clinical trials that do not have a gender-based inclusion criterion has inevitably led to an unequal distribution of participants based on gender. The next step may be to conduct clinical trials that specifically include only women. An initial study was conducted in female patients with aortic valve disease, yielding interesting results and enabling the selection of a more targeted therapy for women. One potential approach to address gender bias could involve developing separate clinical studies. While this may not be immediately feasible, it is not an unrealistic idea. The feasibility of such a project would also depend on the prevalence of the underlying condition, but our study, along with others, represents the initial steps in the right direction."