Background: As of 2016, ≈1.4 million people in the United States identify as transgender. Despite their growing number and increasing specific medical needs, there has been a lack of research on cardiovascular disease (CVD) and CVD risk factors in this population. Recent studies have reported that the transgender population had a significantly higher rate of CVD risk factors without a significant increase in overall CVD morbidity and mortality. These studies are limited by their small sample sizes and their predominant focus on younger transgender populations. With a larger sample size and inclusion of broader age range, our study aims to provide insight into the association between being transgender and cardiovascular risk factors, as well as myocardial infarction. Methods and Results: The Behavioral Risk Factor Surveillance System data from 2014 to 2017 were used to evaluate the cross-sectional association between being transgender and the reported history of myocardial infarction and CVD risk factors. A logistic regression model was constructed to study the association between being transgender and myocardial infarction after adjusting for CVD risk factors including age, diabetes mellitus, hypertension, hypercholesterolemia, chronic kidney disease, smoking, and exercise. Multivariable analysis revealed that transgender men had a >2-fold and 4-fold increase in the rate of myocardial infarction compared with cisgender men (odds ratio, 2.53; 95% CI, 1.14–5.63; P =0.02) and cisgender women (odds ratio, 4.90; 95% CI, 2.21–10.90; P <0.01), respectively. Conversely, transgender women had >2-fold increase in the rate of myocardial infarction compared with cisgender women (odds ratio, 2.56; 95% CI, 1.78–3.68; P <0.01) but did not have a significant increase in the rate of myocardial infarction compared with cisgender men. Conclusions: The transgender population had a higher reported history of myocardial infarction in comparison to the cisgender population, except for transgender women compared with cisgender men, even after adjusting for cardiovascular risk factors.

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Background Bedside ultrasonography in the diagnosis of pneumothorax has been well described in emergency and trauma medicine literature. Its role in detection of iatrogenic pneumothoraces has not been studied. We describe the performance of bedside ultrasonography in detection of procedure related pneumothoraces and highlight some limitations. Methods 185 patients underwent thoracentesis (n=60), transbronchial biopsy (n=48), CT-guided lung biopsy (n=76), and CT-guided cryoablation of a lung mass (n=1). Bedside transthoracic ultrasound examination and post-procedure chest radiograph were performed in all patients. Patients in whom pleural surface was not well imaged with ultrasound were said to have a limited exam. Chest x-ray was the standard for diagnosing pneumothorax. Results Chest x-ray detected pneumothorax in 8/185 patients (4.0%). Ultrasound diagnosed pneumothorax in seven of these patients. Sensitivity, specificity and diagnostic accuracy were 88%, 97% and 97%, respectively. Limited quality ultrasound examinations due to pre-existing lung disease was seen in 43/185 patients. The positive and negative likelihood ratios for patients with adequate scans were 55 and 0.17, respectively. Likelihood ratio for patients with limited quality scan was 1.08. Conclusions Bedside chest ultrasonography, in the presence of good quality scan, is a valuable tool in the evaluation of post procedure pneumothorax. Patients with preexisting lung disease in whom the quality of ultrasound examination is limited should be studied with a chest x-ray.