Women continue to be underrepresented as authors of cardiovascular publications, according to the results of a study of a decade's worth of papers from four cardiovascular journals, published in JACC.

Study authors Ridhima Goel, MD, Roxana Mehran, MD, FACC, et al., for the Women as One Scientific Expert Panel, analyzed 19,503 papers published from Jan. 1, 2010, to Dec. 31, 2019, by four cardiovascular journals: JACC, European Heart Journal, JAMA Cardiology (only included since its first issue in 2016) and Nature Reviews Cardiology. Researchers assessed gender identity manually through online searches. Any papers containing authors whose gender identity could not be confirmed were excluded from the final analysis.

Results showed that of the 111,562 total authors for the 18,535 papers in the final analysis, only 20.6% were women – and nearly half of the papers (47.7%) did not list any women as authors. Conversely, only 6.2% of papers listed no men as authors.

Over the study period, there was little significant change in the proportion of papers with at least one woman as an author, except for an increase in review papers (49.3% to 61.2%) while there was a decrease for woman authorship of "other" or miscellaneous papers (59.8% to 6.6%).

Editorials represented the category for which there was the lowest proportion of women as authors – they accounted for only 14.8% of all editorial authors, and only 23.3% of editorial articles featured a woman author. Research papers had the highest proportion of women authors at 21.8%. Guidelines had the highest proportion of work – 84.7% of all guidelines had at least one woman as an author.

Women accounted for 18.8% of first authors and 11.9% of last authors on papers with at least two authors. The proportion of women as middle authors was highest in papers with women as first and last authors (37.8%) and lowest in papers with men as first and last authors (19.8%).

Looking at the progress by geography, of the 62 countries surveyed, women were <1% of the first authors in 45 countries and <1% of last authors in 34 countries. More women as first authors were affiliated with institutions in the U.S. (34.6%) and the UK (25.2%), and more women were last authors who were affiliated with institutions in the U.S. and the Netherlands (6.5%).

Given that publication productivity is an important metric for promotions in cardiology, gender inequalities in publications not only affect the individual career trajectories of women but also have broader implications for the field's diversity and inclusivity, note the authors. "A call to action is needed to promote women in cardiology and provide them with equitable opportunities," they write.

Proactive measures are needed such as ACC's internal medicine cardiology programs including one targeted to women, along with continuing the work of ACC's Women in Cardiology Member Section, the Diversity and Inclusion Committee and the annual Women in Cardiology Leadership Workshop, along with programs through Women as One and others.

In an accompanying editorial comment, Mary Norine Walsh, MD, MACC, and JoAnn Lindenfeld, MD, FACC, call the study an insight into the "MANuscript," twin to the more familiar concept of the "manel"– an all-male conference panel. "Although the organizers of many cardiovascular conferences have gone to great lengths to ensure the absence of manels," Walsh and Lindenfeld write, "very few cardiovascular journals have made efforts to ensure diversity in the author block."

Among their recommendations to address this issue is calling for the medical publishing industry to institute blinded peer review, increase diversity on journal editorial boards, stress diverse authorship in editorial policies, extend invitations for reviews and editorials to a more diverse group of experts, and track their progress by a more frequent review of metrics.

Keywords: Gender Equity, Publications