Decade of Perseverance and Progress in Women Authorship Trends Across JACC Journals

What is the clinical question being addressed?

Has the representation of women researchers in cardiology improved over the past decade?

What is the main finding?

Despite an enduring gender gap, there is an encouraging trend in women-led research published in the JACC journals. Interventional cardiology and electrophysiology have the lowest percentage of women authors.

The past decade has seen a steady rise in women entering medical training. However, cardiology remains overwhelmingly male-dominated. While nearly half of the internal medicine residents are women, the figure drops to 21% among cardiology fellows.¹ Whether women find the field with its buzzing cardiac catheterization labs and myriad imaging techniques to be truly unappealing or the societal constructs disproportionately disadvantage women, thus throwing them off the field, needs to be pondered upon. Paucity of women role models, radiation concerns, and the subtle yet alive prejudice that still lingers on in the branch might be some reasons why women opt against cardiology.

In line with this, women remain significantly underrepresented in cardiology research leadership. This inequity directly translates to the glaring gap in women’s heart health research and their under-enrollment in trials.² Over the past decade, the global cardiology community has launched initiatives to address this gender gap. JACC and its portfolio of subspecialty journals are benchmarks in the field, and analyzing their authorship disparities offers a valuable proxy for assessing the real-world influence of these inclusivity efforts.

We conducted a bibliometric review of JACC journals to assess the trends in women’s first and last authorship. The SCOPUS database was searched during August to September 2025 for publications in JACC, JACC: Cardiovascular Imaging, JACC: Cardiovascular Interventions, JACC: Heart Failure, JACC: Clinical Electrophysiology, JACC: Asia, JACC: Advances, and JACC: CardioOncology. Publications from January 2015 (from inception for newer journals) to December 2024 were included. The search was limited to original investigations (including case reports) and reviews. SCOPUS export was used to extract bibliometric data. First and last author gender was determined from first names using Genderize.io³ with a probability threshold ≥90%, which was higher than prior studies.^2,4 Names with lower probability were manually verified (affiliated institutional profiles or professional social media). Authors with indeterminate gender were excluded. Women authorship trends were assessed using linear regression by year. The association between first and last author gender was evaluated by OR. Citation counts were compared using Mann-Whitney U test.

We identified 24,376 publications and included 10,823 for gender determination after initial screening and exclusion based on article type. Among 1,310 author names with Genderize.io probability <90%, gender remained indeterminate for 433 after manual verification. Both first and last author gender was determined for 10,390 (95.9%) articles which were included in the final analysis.

Overall, 2,228 publications had women first authors (21.4%), and 1,483 publications had women senior authors (14.3%). Women first authorship increased from 17.7% in 2015 to 27.2% in 2024, that is, by 0.96% per year (95% CI: 0.42%-1.72%; P = 0.001) and last authorship by 1.07% per year (95% CI: 0.67%-1.47%; P = 0.0009) from 10.9% to 20.6% (Figure 1B).

Figure 1.

Temporal and Geographic Trends in Women Authorship

(A) Bibliometric world map depicting women first authorship by country. (B) Temporal trends of women first and last authorship across subspecialty journals.

JACC: Cardiovascular Interventions and JACC: Clinical Electrophysiology had the lowest women first authorship, at 13% and 15%, respectively, mirroring the persistent underrepresentation of women in these branches. Newer journals, JACC: CardioOncology (38%) and JACC: Advances (30%), had less pronounced gender disparities.

The median number of citations for women and men first-authored publications were 28 (8-71) and 26 (7-69), respectively, and difference was not significant statistically (P = 0.052). This finding challenges the subtle yet pervasive bias regarding the merit of women-led research.

The odds of a woman first author seeking mentorship from a senior woman author were significantly higher (OR: 2.21; 95% CI: 1.95-2.51). Among papers with women senior authors, 33.7% had women first authors, compared with 18.6% for men senior authors. Similar to prior studies,^4,5 this highlights the influence of senior role models in encouraging women to pursue cardiovascular research. Women cardiologists not only provide academic mentorship but also a sense of belonging for younger women advancing through the field.

Most publications were from the United States (n = 4,925), followed by the United Kingdom (n = 545), Canada (n = 530), Japan (n = 512), and Italy (n = 450). Women authorship varied significantly across the nations. The United States had the largest number of women first authors (n = 1,132), corresponding to 22.9% of its publications. Canada (n = 120, 22.6%), United Kingdom (n = 112, 20.5%), Netherlands (n = 100, 28.0%), and Spain (n = 82, 29.5%) also contributed substantially to women first authorship. Among the 17 countries with at least 50 publications, Netherlands (28.9%), Sweden (29.5%), and Spain (29.5%) had higher proportion of women first authors while Japan (8.5%), Germany (14.2%), and Italy (15.4%) reported lower percentages (Figure 1A).

This striking asymmetry is not a mere coincidence but the result of strategic, policy-driven reforms. By tying research funding to measurable gender-equity targets, encouraging work–life balance, and programs like the Aspasia, Netherlands, enabling women’s promotion to senior academic roles, these countries have transformed gender equity into a plausible reality rather than mere rhetoric restricted to paper. International mentorship collaborations, funding opportunities, and adapting successful global policy interventions to regional academic and cultural contexts can help empower women researchers worldwide.

To our knowledge, this is the first study to comprehensively analyze gender representation in cardiology research across wide spectrum of subspecialties. The JACC family of journals offers a unique lens to examine persistent disparities at the highest levels of professional excellence. One of the limitations of the study was that the gender of authors with gender-neutral names could not be determined, particularly those of Asian origin.

Moreover, the JACC journals have long been working toward gender equity with initiatives like the diversity and inclusivity task force and women in cardiology section. While this may account for the favorable trend in this study, same might not be reflected across broader cardiology research landscape.

What are the future implications?

Research authorship is a mirror for professional representation and advancement. As a community that prides itself on its adaptability and innovation, we hold a responsibility to our medical school graduates to offer a welcoming hand, to our fellows-in-training and women researchers the opportunity to outreach the glass ceiling and by extension, to our female patients, the right to scientifically enriched health care. Active efforts to implement gender-equity policies, strengthening mentor–mentee programs and professional support networks for women can narrow the gender gap, empowering women in cardiology.

Funding support and author disclosures

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.