It is well documented that women are underrepresented in leadership within academic medicine. In biomedical sciences, they account for almost half of postdoctoral fellows but only 19% of tenured senior investigators. 1 Cardiology lags behind other internal medicine specialties with regard to women entering the field and achieving leadership positions. 2 However, little is known about women in cardiovascular clinical trial leadership. In this study, we describe their representation within leadership committees of clinical trials, as well as in lead authorship positions of ensuing trial publications.Methods | Because this quality improvement study did not involve patients, it was not subject to approval per the institutional review board specifications at the Cleveland Clinic. For this study, we included cardiovascular medicine publications presenting clinical trial results published in JAMA,

Kawasaki disease is the most common childhood vasculitis in the USA and the most common cause of acquired cardiac disease in children in developed countries. Since the vast majority of Kawasaki disease initially presents at <5 years of age, many adult cardiologists are unfamiliar with the pathophysiology of this disease. This vasculitis has a predilection for coronary arteries with a high complication rate across the lifespan for those with medium to large coronary artery aneurysms. An inflammatory cascade produces endothelial dysfunction and damage to the vascular wall, leading to aneurysmal dilatation. Later, pseudonormalisation of the vascular lumen occurs through vascular remodelling and layering thrombus, but this does not necessarily indicate resolution of disease or reduction of risk for future complications. There is a growing prevalence of Kawasaki disease, making it increasingly relevant for adult cardiologists as this population transitions into adulthood. As the 2017 American Heart Association (AHA) and 2014 Japanese Circulation Society (JCS) guidelines emphasise, Kawasaki disease requires rigorous follow-up with cardiac stress testing and non-invasive imaging to detect progressive stenosis, thrombosis and luminal occlusion that may lead to myocardial ischaemia and infarction. Due to differences in disease mechanisms, coronary disease due to Kawasaki disease should be managed with different pharmacological and non-pharmacological treatment algorithms than atherosclerotic coronary disease. This review addresses gaps in the current knowledge of the disease and its optimal treatment, differences in the AHA and JCS guidelines, targets for future research and obstacles to transition of care from adolescence into adulthood.

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Nonresponders have higher rates and greater severity of coronary involvement than responders. Our study uniquely demonstrates Black race as a risk factor for nonresponse and for delayed normalization of cardiac involvement at 1-year follow-up.

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Dr. Ellis has disclosed speaking, teaching, consulting, or serving on an advisory committee for Medtronic.