Assessing and Addressing Cardiovascular Health in LGBTQ Adults: A Scientific Statement From the American Heart Association

Abstract

There is mounting evidence that lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) adults experience disparities across several cardiovascular risk factors compared with their cisgender heterosexual peers. These disparities are posited to be driven primarily by exposure to psychosocial stressors across the life span. This American Heart Association scientific statement reviews the extant literature on the cardiovascular health of LGBTQ adults. Informed by the minority stress and social ecological models, the objectives of this statement were (1) to present a conceptual model to elucidate potential mechanisms underlying cardiovascular health disparities in LGBTQ adults, (2) to identify research gaps, and (3) to provide suggestions for improving cardiovascular research and care of LGBTQ people. Despite the identified methodological limitations, there is evidence that LGBTQ adults (particularly lesbian, bisexual, and transgender women) experience disparities across several cardiovascular health metrics. These disparities vary by race, sex, sexual orientation, and gender identity. Future research in this area should incorporate longitudinal designs, elucidate physiological mechanisms, assess social and clinical determinants of cardiovascular health, and identify potential targets for behavioral interventions. There is a need to develop and test interventions that address multilevel stressors that affect the cardiovascular health of LGBTQ adults. Content on LGBTQ health should be integrated into health professions curricula and continuing education for practicing clinicians. Advancing the cardiovascular health of LGBTQ adults requires a multifaceted approach that includes stakeholders from multiple sectors to integrate best practices into health promotion and cardiovascular care of this population.

Differences in Multimorbidity among Cisgender Sexual Minority and Heterosexual Adults: Investigating Differences across Age-Groups

“…Data from cohort studies indicate that more than half of transgender adults are currently on gender-affirming hormones (James et al, 2016; Kidd et al, 2019). Given that the BRFSS does not include data on gender-affirming hormone use, a potential contributor to chronic disease development in transgender adults (Braun et al, 2017; Caceres et al, 2020), we excluded all transgender participants ( n = 3524), regardless of their sexual identity. To reduce potential misclassification of transgender persons as cisgender, we also excluded participants who responded do not know ( n = 5740) or refused ( n = 7453) to the gender identity item.…”

Influence of Stress, Gender, and Minority Status on Cardiovascular Disease Risk in the Hispanic/Latino Community: Protocol for a Longitudinal Observational Cohort Study

“…Despite the heavy impact of CVD in Hispanic/Latino communities and the data that Hispanic/Latino populations are more likely to report being SGM, remarkably little research has focused on CVD in the Hispanic/Latino SGM population [ 83 ]. Leveraging the infrastructure of the existing HCHS/SOL cohort, SGM SOL will examine relationships among stigma, discrimination, minority stress, and CVD in this population [ 84 ].…”

Gender and Cardiovascular Disease Risk: Beyond the Binary

“…The large cohort studies that underlie our current understanding of cardiovascular disease risk factors (eg, Framingham Heart Study, Multi Ethnic Study of Atherosclerosis) do not include data on gender identity. 12 This limitation has significant implications for the understanding of cardiovascular disease risk and the application of risk assessment tools to TGNC populations. The current evidence about TGNC cardiovascular disease prevalence and risk factors, while limited, was identified in the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System survey, which has included gender identity data since 2014.…”

“…21 Another model recently proposed by the American Heart Association suggests that cardiovascular disease morbidity and mortality in lesbian, gay, bisexual, transgender, and queer or questioning people is moderated by an interrelated combination of traditional cardiovascular disease risk factors, life stressors, and psychosocial, behavioral, and physiologic factors. 12 The minority stress model, widely used in psychology, proposes that environment and events, anticipation of stress, and internalization of experienced discrimination contribute to negative outcomes. 22 This model has been used to explain some TGNC health disparities, including in mental health, health-promoting behaviors, substance abuse, quality of life, and access to care.…”

“…Researchers should collect complete and accurate data about gender identity and strive for inclusive study populations. 12 The research community should develop and implement standardized language for gender identity to facilitate the inclusion and analysis of this information. Because gendernonconforming people are underrepresented in the current evidence, assessment of gender identity should include language capturing gender-nonconforming identities, and sampling plans should deliberately include them.…”