Cardiovascular Disease Risk Factors and Myocardial Infarction in the Transgender Population

Abstract

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.

An Observational Study of Hypertension and Thromboembolism Among Transgender Patients Using Gender-Affirming Hormone Therapy

“…Multiple previous studies have shown no association between hormone treatment and CVD for transmen, 6,12,22,23,25 consistent with our findings; a recent study did find an increase risk for selfreported CVD among transmen, although this was not attributed specifically to hormone use. 33 There are important limitations to this study. The analysis was observational in nature and clinicians may have prescribed certain hormones based on their patients' CVD risk, which we are unable to control for; likewise, hormone concentrations were available when tests were ordered by clinicians, and may have been more common when there were clinical concerns.…”

Transgender individuals' cancer survivorship: Results of a cross‐sectional study

“…Transgender women also had higher odds of diabetes and cardiovascular disease compared with cisgender men and cisgender women. Recent studies that examined transgender individuals' health irrespective of cancer did not report elevated rates of diabetes, but did demonstrate elevated cardiovascular disease in transgender men and transgender women. Although additional studies, including longitudinal studies, of transgender cancer survivors' health behaviors and health are needed, clinicians need to be aware of the likely more complex medical care needs of transgender men and transgender women with cancer, given their poor physical health, especially their comorbid diabetes and cardiovascular disease.…”

Cardiovascular disease in transgendered people: A review of the literature and discussion of risk

“…However, after adjusting for age, diabetes mellitus, chronic kidney disease, smoking, hypertension, hypercholesterolemia, and exercise, transgendered women only had a significantly increased risk of MI compared to cisgendered females (odds ratio [OR], 2.56; 95% CI: 1.78–3.68; p < 0.01) but not cisgendered men. 12…”

“…After adjustment for cardiovascular risk factors, however, the study demonstrated that transgendered men had an increased risk for MI compared to both cisgendered populations (OR 2.53 95% CI: 1.14–5.63 compared to cisgendered men; OR 4.90 95% CI: 2.21–10.90 compared to cisgendered women). 12…”