Purpose: The proportionate inclusion of women in clinical trials is vital to improve the population external validity of these trials and to aid decision-making in this population group. Historically, there has been underrepresentation of women in clinical trials relative to disease burden in numerous fields, including oncology, neurology, haematology, immunology and cardiovascular medicine/surgery. Methodology: We have reviewed the literature regarding the extent to which women are underrepresented in cardiovascular trials, the implications of this lack of representation on vascular surgical clinical outcomes, barriers to participation and potential facilitators that can be implemented in future studies to improve cardiovascular outcomes for women. Results/Conclusion: Underrepresentation of women relative to disease burden in cardiovascular clinical trials has been persistent and is well-documented across various cardiovascular fields, including stroke, cardiovascular medicine, cardiac surgery and vascular surgery. Studies with invasive interventions, trials with older aged participants and those with “hard” primary outcomes have lower enrolment rates of women. This leads to a paucity of information regarding the benefits, risks and outcomes of therapies and interventions, exacerbating the complexity of patient and physician decision making for female patients with cardiovascular disease.