Closing the Gap: New ASPC Working Group Elevating Women Leaders in Preventive Cardiology

What gaps in representation, mentorship, and leadership prompted the creation of the American Society for Preventive Cardiology (ASPC) Working Group focused on women in preventive cardiology, and what are its core objectives for supporting women professionals in this field?

This working group was created in response to several persistent gaps: underrepresentation, mentorship/sponsorship, leadership and pipeline.

1. Underrepresentation – Women remain underrepresented across the preventive cardiology landscape, whether in leadership roles within programs, professional societies and guideline committees; as senior authors on prevention trials and position statements; or on major plenary stages and continuing medical education programs focused on prevention. Women of colour are even less visible at every level, from fellowship through full professor and system-level leadership, underscoring the compounded gaps in representation that our field must address.
2. Mentorship/sponsorship – Many early- and mid-career women in preventive cardiology report significant mentorship and sponsorship gaps. They often have few, if any, mentors who are themselves women in this subspecialty, and they lack sponsors who will actively advocate for their promotion, speaking invitations, awards and leadership appointments. In addition, there is limited transparency around “how things actually happen”, including how program directorships, national committee roles, or trial leadership opportunities are identified and filled, leaving many women without the insight or access needed to navigate these critical career milestones.
3. Leadership and pipeline – Leadership and pipeline gaps persist in preventive cardiology because there is no consistent, structured system to identify women trainees and early-career clinicians who are interested in prevention and intentionally develop them for future roles as clinician-scientists, program directors, division chiefs and society leaders. Leadership development remains largely informal and opaque, heavily dependent on pre-existing networks and sponsorship channels that have historically excluded women, resulting in missed opportunities to cultivate and advance a diverse cadre of women leaders in the field.

The core objectives of the working group: representation, community and leadership development.

• Representation: Increase the visibility and representation of women in preventive cardiology across: ASPC (committee, board, task forces etc.), media and advocacy.
• Community: Our goals are to build structured mentorship and sponsorship pathways for women at all career stages, create a visible network of women in preventive cardiology across institutions and regions, and provide a professional “home” where women can share experiences, strategies and opportunities to advance together.
• Leadership development: We aim to prepare women to lead preventive cardiology programs, clinical enterprises, research consortia and professional societies, and to ensure that women are not just present but truly influential in the decisions that shape prevention guidelines, funding priorities and models of care.

What structural and cultural barriers continue to limit recruitment, retention and advancement of women in preventive cardiology, and how can institutions address these challenges in meaningful, measurable ways?

Structural barriers:

1. Workload and compensation inequities
   • Women frequently carry higher clinical loads, more non-relative value unit-generating tasks and more administrative.
   • Gender pay gaps persist, even when controlling for rank and productivity.
   • Lack of transparency of transparent salary and incentive structures obscures disparities.
2. Opaque promotion and leadership pathway
   • Criteria for promotion, protected time for research or program-building, and selection for leadership roles are often informal and inconsistently applied.
3. Limited structured support for research careers
   • Women often have less protected time, fewer bridge funds and reduced access to institutional resources that enable them to become independent investigators
   • Senior collaborators and mentors for women-focused prevention research remain relatively scarce.

Cultural barriers:

1. Persistent bias and stereotype-based on assumption
   • Women are often seen as “less committed” or “less available” for leadership or research roles, especially during child-bearing years.
   • Expertise is questioned more frequently; women are over-scrutinized
2. Exclusion from informal networks
   • Women often have fewer opportunities for informal mentoring and sponsorship that lead to high-impact roles
3. Microaggression, harassment, and climate issues
   • Subtle (and sometimes overt) microaggressions, interrupted speech, diminished credit and inappropriate comments erode retention and engagement.
   • Lack of visible accountability discourages reporting and fosters resignation.

Proposed solution/intervention:

1. Make processes and metrics transparent
   1. Publishing clear criteria for promotion, leadership roles and compensation.
   2. Track and publicly share gender-stratified data on hiring, promotion and retention.
2. Redesign workload and recognition systems
   1. Conduct regular, independent pay-equity analyses and correct disparities promptly.
   2. Ensure clinical and call schedules are equitable

3. Build safe and inclusive cultures with accountability
   1. Implement and enforce zero-tolerance policies for harassment and discrimination, with clear reporting pathways and protections from retaliation.
   2. Offer bystander training and bias mitigation training that is practical and scenario based.
   3. Regularly assess department climate and act on findings with tangible interventions.

How can mentorship, sponsorship and leadership development initiatives within preventive cardiology be optimized to ensure a robust pipeline of women clinician–scientists and program directors?

To ensure a robust pipeline of women clinicians, we need structured processes. This includes moving from informal to intentional systems, with formal mentoring programs that match mentees to mentors locally and across institutions, use multi-mentor access for clinical work, research, leadership and work–life integration, and incorporate cross-gender and cross-discipline mentoring with a focus on prevention.

We must distinguish mentorship from sponsorship, with mentors advising and sponsors actively using their influence to open doors.

Senior leaders should have clear sponsorship expectations, such as nominating women for speaking roles, awards, task forces and leadership positions, recommending them for trial leadership, steering committees and editorial boards, and tracking how many women are put forward for visible roles each year.

Targeted leadership development is also essential, including structured training in leading prevention programs and multidisciplinary teams, core management skills, and media communication and advocacy in cardiovascular prevention.  These efforts must be paired with systematic outcome measurement (e.g. women in key leadership roles, publications and authorship, etc.), and used to refine mentoring and leadership programs annually.

The ASPC Women in Preventive Cardiology Working Group is using the society’s platform to formalize and spread a structured mentoring program.

In what ways will increasing the representation of women in preventive cardiology translate into improved cardiovascular risk assessment, prevention strategies and outcomes for women?

Improving representation is not merely an equity issue; it is a quality-of-care and public health issue, because it directly shapes how cardiovascular prevention is understood, delivered, and optimized for women. Women clinicians and investigators are more likely to recognize sex-specific risk enhancers (such as preeclampsia, gestational diabetes, preterm birth, early menopause and autoimmune disease) and sex differences in symptom presentation, microvascular disease and arrhythmias, leading to more appropriate use of risk calculators and imaging and greater recognition of underdiagnosed conditions such as ischemia with non-obstructive coronary arteries (INOCA), myocardial infarction with non-obstructive coronary arteries (MINOCA) and heart failure with preserved ejection fraction (HFpEF). Women in leadership roles tend to push for prevention strategies that reflect women’s lived experience, including integration of pregnancy and reproductive history into cardiovascular risk workflows and attention to psychosocial stressors, caregiving demands and social determinants that disproportionately affect women, resulting in more personalized prevention plans and greater attention to adherence barriers, medication tolerability and realistic lifestyle interventions. When women are at the table for research and guideline development, trial design is more likely to ensure adequate enrolment of women and sex-specific analyses, and guidelines are more likely to explicitly address women’s risk factors, diagnostic pathways and evidence gaps, strengthening the evidence base that informs clinical practice. Representation also improves patient trust, engagement and communication, as many women feel more comfortable discussing symptoms, reproductive history and psychosocial stress with women clinicians.

What specific policy, research, or workforce initiatives is the working group prioritizing to simultaneously advance career equity for women in preventive cardiology and close persistent gaps in cardiovascular outcomes among women?

Our Working Group is advancing initiatives that simultaneously promote career equity for women professionals and improve cardiovascular outcomes for all patients by advocacy for workforce standards and improving gender/diversity representation.

We plan to invest in workforce and leadership development via formal ASPC mentorship and sponsorship programs, community-engaged care, and deliberate visibility and recognition efforts that position women as default experts, speakers and leaders in preventive cardiology.

References

1. The American Society for Preventive Cardiology. Women in Preventive Cardiology Working Group. Available at: www.aspconline.org/women-in-preventive-cardiology (accessed 13 March 2026).

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