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Black participation in hypertrophic cardiomyopathy trials is only 3.98% of the expected shareBlack patients are underrepresented in heart muscle disease trials

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Key Takeaway
Note that Black participation in hypertrophic cardiomyopathy trials is significantly lower than population expectations.

This meta-analysis evaluated 13 interventional hypertrophic cardiomyopathy trials involving 1,780 Black or White participants. The study aimed to quantify the representation of Black participants and identify factors influencing enrollment, such as site geography and eligibility thresholds.

The primary finding was a pooled Black share of only 3.98% (95% CI 2.68-5.86) among the participants. The participation-to-prevalence ratio (PPR) was 0.24 (95% CI 0.16-0.36), which was the lowest of any racial and/or ethnic minority group. The analysis determined that neither site geography nor specific eligibility thresholds were the primary drivers of this enrollment gap, as the impact of eligibility thresholds was only 2.0%.

The results indicate that Black participation was approximately one quarter of the population expectation. While the study identifies a significant gap between Black population prevalence and trial participation, it suggests that the shortfall is not primarily due to geographic location or specific inclusion criteria. These findings highlight a significant disparity in clinical trial access for Black patients with hypertrophic cardiomyopathy.

How this fits prior evidence

This meta-analysis addresses a gap in understanding trial diversity for hypertrophic cardiomyopathy. While prior coverage has focused on therapeutic interventions like cardiac myosin inhibitors, exercise, and diagnostic tools like AI-empowered echocardiography, this study highlights a significant disparity in the representation of Black patients in clinical trials. Specifically, the finding that Black participation is only 3.98% of the expected share highlights a systemic issue in trial recruitment that may impact the generalizability of findings for the broader hypertrophic cardiomyopathy population.

Living with hypertrophic cardiomyopathy, a condition where the heart muscle becomes abnormally thick, can be frightening. When new treatments are developed, they rely on clinical trials to prove they work. However, a new look at these trials reveals a troubling gap in who gets to participate in the research.

Researchers looked at 1,780 participants across 13 different trials for this heart condition. They found that Black participants made up only about 4% of the group. This number is much lower than what would be expected based on the actual number of Black people living with this disease in the general population. In fact, the participation rate for Black patients was only about one quarter of what it should have been.

Investigators looked for reasons why this gap exists. They checked if the location of the clinics or the specific medical rules for joining a study caused the low numbers. They found that neither the location of the site nor the strictness of the entry rules were the main reasons for the low turnout. This suggests that other factors are keeping Black patients out of these important medical studies.

What this means for you:
Black patients are significantly underrepresented in heart muscle disease trials compared to their prevalence in the population.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a pan-ethnic disease, at least as common in Black as in White Americans, yet Black patients reach specialist care later, undergo septal reduction less often, and die sooner. Whether the defining trials enrolled representatively is unknown. We sought to measure Black participation in the landmark HCM trials against three expectations of increasing stringency, and to test whether trial site geography or quantitative eligibility thresholds account for the shortfall. METHODS: Of 197 registered interventional HCM trials, 32 met prespecified landmark tiers; demographics were extracted for 16 and 13 reported race. The Black share of Black plus White participants was pooled by random-effects meta-analysis and compared with the US adult population, with each trial?s own site counties, and with a disease-referenced echocardiographic expectation. Site geography and eligibility thresholds were tested using site addresses, census data, and NHANES. RESULTS: Across 13 trials, 70 of 1,780 Black or White participants were Black. The pooled Black share was 3.98% (95% CI 2.68-5.86), against a population expectation of 16.5%, giving a participation-to-prevalence ratio (PPR) of 0.24 (95% CI 0.16-0.36), the lowest of any racial and/or ethnic minority group. The clinical trial site network reached 63.7% of Black and 47.5% of White US adults, with geospatial analysis predicting 26.4% Black enrollment; however, every trial fell below this expectation. Quantitative eligibility thresholds closed only 2.0% of the enrollment gap. CONCLUSIONS: Black participation was about one quarter of the population expectation. Neither site geography nor eligibility thresholds explain it.
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