"A self-perpetuating malaise in the system:" Understanding scientists' perspectives on the sex/gender gap in cardiovascular disease research

Longstanding evidence demonstrates that integrating sex-based biological factors and gendered social factors in health research enhances understanding of variation in risk factors, symptoms, progression, diagnoses, and treatments of diseases, and leads to more targeted interventions and improved health outcomes. Sex and gender-based analysis (SGBA) provides a framework for integrating sex/gender and other social constructs and locations throughout the research cycle, addressing the fundamental question: to whom does the evidence apply? Cardiovascular disease (CVD), as the major cause of mortality for men and women globally, and the major cause of premature death in women in Canada, provides a prime example of the gap between evidence that sex/gender matters and the routine uptake of SGBA in practice. This paper addresses some of the transformations needed to overcome this gap by exploring scientists perspectives on how sex/gender considerations can be routinely integrated in basic and clinical CVD research. Grounded in key informant interviews with 19 federally-funded CVD scientists in Canada, our thematic analysis generated three themes highlighting how barriers to integrating sex/gender in basic and clinical research practice become embedded in the everyday doing of research: (1) The science of sex/gender gets lost in practice, (2) Institutional and systemic processes maintain the status quo, and (3) Change must centre on accountability and community. While scientists appreciated how SGBA could strengthen research veracity, they identified major obstacles as well as mundane institutional practices and procedures that reinforced the status quo and impeded more varied approaches to research and data collection. Drawing together the bricolage of insights, examples, and suggestions provided by the scientists we spoke with, we offer key actions and guidance towards greater inclusivity of sex/gender in the scientific paradigm, and specifically, in CVD research that shapes clinical practice.