Characteristics of Transgender Women Referred to Women's Heart Clinic

Abstract

Introduction Transgender women have been reported to have a high burden of cardiovascular disease (CVD) and risk factors based largely on surveys. Our aim was to describe the prevalence of CVD and associated comorbidities among a cohort of older transgender women referred to cardiology as part of their gender-affirming care. Methods This was a retrospective, cross-sectional study of transgender women at a single institution from 2017 to 2019. Results Fifty-two consecutive patients were included. The most common reasons for referral were cardiac risk factor management (45%) and pre-operative cardiac risk stratification prior to gender-affirming surgery (35%). The mean age was 57 ± 10 years, 87% were white, and 92% had insurance coverage. Forty-eight patients (92%) were taking gender-affirming hormone therapy; 5 had undergone breast augmentation, 4 had undergone orchiectomy, and 2 had undergone vaginoplasty. The most common comorbidities were depression and/or anxiety (63%), obesity (58%), and hyperlipidemia (54%). Excluding aldosterone antagonists, 46% were on cardiac medications; changes were recommended for 25% of patients: new prescriptions in 9, dose adjustments in 5, and discontinuations in 4. According to the pooled cohort equation, the 10-year risk of atherosclerotic CVD was 9.4 ± 7.7% when the study population was calculated as male and 5.2 ± 5.1% when calculated as female ( p <0.001). For patients who completed exercise testing, the functional aerobic capacity was fair (77.6 ± 21.4%) when calculated as male and average (99.5 ± 27.5%) as female ( p < .0001); there was inconsistency in sex used for calculating the result on the formal report. Conclusions Older transgender women may have an underestimated prevalence of CVD and its risk factors. More research is needed to identify cardiovascular health profiles, improve practice consistency, and establish normative values for transgender patients.

Implicaciones cardiovasculares de la terapia hormonal cruzada en el proceso de feminización

“…La investigación actual sobre comorbilidades cardiacas de las personas transgénero que reciben terapia hormonal cruzada durante el proceso de feminización, es muy limitada debido a los escases de estudios cohortes con un gran número de participantes (12)(13)(14)(15) Contrario a esto, se establece que la edad de inicio es solo un punto de tantos a considerar, para el inicio de la terapia de feminización, ya que se deben tener en cuenta de igual forma, los antecedentes de enfermedades hereditarias que puedan comprometer la homeostasis del organismo una vez iniciado la THC (10). Por su parte, se remarcan la edad y la genética de esta población, como punto de valoración para el inicio de cambio donde determinan que la forma para instaurar esta terapia debe de ser de forma escalonada, a partir de los 16 años hasta la de 18 años de edad, en donde se puede hacer una posterior valoración para la instauración definitive de la THC para este proceso de cambio.…”

“…Para suprimir los caracteres sexuales del sexo biológico, se pueden usar compuestos con efecto anti andrógeno, entre ellos están; la terapia con estrógenos, el cual se puede administrar por tres vías oral (Estradiol), transdérmica (valerato de estradiol) y parenteral (cipionato) (10)(11)(12)(13)(14)(15)(16)(17)(18)(19); La terapia con antiandrógenos, por vía oral (espironolactona, acetato de ciproterona) y transdermica (agonistas de GnRH) (10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Además, el seguimiento debe complementarse con exámenes como: Hemograma, niveles de creatinina, ionograma, función hepática, niveles de glucemia y perfil lipídico.…”

What Cardiothoracic Radiologists Should Know About Imaging in Transgender Patients

“…To our knowledge, no studies have clearly linked GAHT with changes in coronary calcium or coronary plaque burden. In a small retrospective cohort of transfeminine persons referred for cardiovascular disease testing, 3/7 (43%) presented with detectable coronary calcium with percentile ranges varying from 37% to 88% according to male sex controls and 56% to 97% compared with female sex controls 31. No official guidelines exist as to how radiologists should be applying reference ranges to calcium scoring CT of TGD persons.…”

“…In a small retrospective cohort of transfeminine persons referred for cardiovascular disease testing, 3/7 (43%) presented with detectable coronary calcium with percentile ranges varying from 37% to 88% according to male sex controls and 56% to 97% compared with female sex controls. 31 No official guidelines exist as to how radiologists should be applying reference ranges to calcium scoring CT of TGD persons. Further study is needed to determine the application of sex-based nomograms to determine cardiovascular risks among TGD persons.…”

Cardiac Mechanics in Altered Hormonal States as a Surrogate for Understanding the Effects of Transgender Hormone Therapy

“…A retrospective cross-sectional study of 52 transgender women referred to a women's cardiology clinic at The Mayo Clinic found that 92% were on GAHT regimens, while the most common reasons for referral were cardiac risk factor management and risk stratification before gender-affirming surgery. 10 As detailed above, much of the current literature has focused on MI rates and changes in biomarkers. However, in comparison to these topics, the effects of GAHT on cardiac mechanics-such as systolic and diastolic dysfunction-are less well-characterized in the literature.…”