Asia-Pacific Investigators and Asian Enrollment in Cardiometabolic Trials: Insights From Publications Between 2011 and 2020

• Published in: JACC. Asia 2023-10, Vol.3 (5), p.724-735
• Main Authors: Azzopardi, Robert, Nicholls, Stephen J, Nerlekar, Nitesh, Scherer, Daniel J, Chandramouli, Chanchal, Lam, Carolyn S P, Muthalaly, Rahul, Tan, Sean, Wong, Christopher X, Chew, Derek P, Zoungas, Sophia, Yeo, Khung Keong, Nelson, Adam J
• Format: Article
• Language: English
• Subjects: Original Research
• ISSN: 2772-3747
• DOI: 10.1016/j.jacasi.2023.05.010

A lack of geographic and racial diversity in clinical trial populations may arise from a disproportionate focus on the United States and Europe for trial leadership and conduct. Inadequate diversity may compromise the external validity to the Asia-Pacific (APAC) region, where 60% of global cardiometabolic disease exists. This study aimed to assess the proportion and trends of Asian race participants and APAC authorship in cardiometabolic trials. We performed a systematic review of all cardiovascular, diabetes and obesity-related randomized controlled trials (phase ≥2, n = ≥100) published in these major medical journals: the , the , and the between January 1, 2011, and December 31, 2020. Trial leadership was defined by first authorship, and any listed author was considered a trial collaborator. Temporal trends were evaluated using the Jonckheere-Terpstra proportion test and correlations using Pearson's correlation coefficient. Participant-to-prevalence ratios (PPR) were determined using Global Health Data Exchange registry data. A total of 8.3% (218,613 of 2,619,710) participants identified as being of Asian race and 7.7% of total enrollment occurred in APAC. APAC lead authorship occurred in 52 of 656 (7.9%) trials and collaboration in 10.1% (1312 of 13,000 of authors), which correlated with Asian enrollment (  = 0.63 and  = 0.76, respectively). A marginal increase in the proportion of Asian race (Δ1.40% ± 6.95%/year,  = 0.003) and APAC regional (Δ1.46% ± 8.67%/year,  = 0.003) enrollment was observed; however, severe regional underrepresentation persisted (PPR