We appreciate your interest and insightful comments regarding our article [1]. Apart from the issue of gender-related differences in the management of cardiovascular diseases [2], also women’s underrepresentation in cardiology journals has been receiving growing attention, as reflected by our paper [3]. Six weeks after its submission, a similar analysis of articles from 2015 to 2023 was submitted to Advances in Interventional Cardiology by Zdzierak et al. [4] and published in June 2024, showing that first female authors constituted 68 (22.8%) and 24 (24.7%) for original articles and short reports, which is lower than in our study (274 [32.7%] and 87 [34.5%], respectively). Zdzierak et al. [1] reported that author gender did not influence the citation rate of all or original papers only. While this is of interest, no such analysis was included in our study [3], which was acknowledged by us to be an important limitation.
Regarding the underrepresentation of women among authors in interventional cardiology during the last decade, we found that women constituted 17% of authors in this field, while Zdzierak et al. [4] showed that women represented 2.4% of first authors in original articles. In our study ‘interventional cardiology’ papers were defined as the sum of those on percutaneous coronary interventions, along with structural, peripheral, and electrotherapy interventions, which led to a larger number of articles assessed in this category, which in part at least, explains the differences mentioned by Zdzierak et al. [4]. Evaluation of studies solely on coronary interventions published in Kardiologia Polska (Polish Heart Journal) in 2023 demonstrated that 4.5% of original papers had a first female author, while none had a female corresponding or senior author. For clinical vignettes, female first, female corresponding, and female senior authors constituted 6.8%, 5.1%, and 3.4%, respectively. None of the short communications in 2023 had a woman in any of these positions.
To address the issue of the Pareto principle in the Polish Heart Journal, suggested by Zdzierak et al. [1], we calculated the number of manuscripts by particular authors in 2023. We found that none of the women who published a paper concerning heart interventions authored more than one manuscript in 2023, which does not confirm the Pareto principle. We agree with Zdzierak et al. [1] that a person responsible for writing a manuscript may not be a certified operator, which could be another explanation for the higher representation of women authors when compared to women operators in Poland.
Zdzierak et al. [1] stated in the letter that “women are less interested in interventional procedures”. In our opinion, this is not the case, which may be supported by a study by Grines et al. who presented three potential reasons: the physical burden, breaks for women during pregnancy planning and pregnancies themselves due to radiation, and the attitude in the professional environment [5]. We agree with the authors that some of the articles are authored by non-certified operators, non-interventional cardiologists, residents, and students, but this shows that, contrary to the above statement [1], women are interested in interventional cardiology, but do not proceed to become operators, which suggests they are not supported or are even discouraged, examples of which are not uncommon. We know a case from one of the reference interventional cardiology centers in Poland where physicians were told by their superior “not to encourage” a female intern who declared interest in a career in interventional cardiology. Most likely, several similar situations could be reported.
Recently, it has been discussed that for women robotic-assisted technology could help reduce concerns about radiation exposure that may affect pregnancy, while also decreasing the physical demands that are obstacles for both men and women [5].
We hope that our reply will stimulate further discussion on the gender gap in cardiology and consequently increase institutional support for female cardiologists.
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Conflict of interest: None declared.
Funding: None.
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