Summary: New research finds that transgender men report heart attack rates more than four times those of cisgender women and more than twice those of cisgender men. Transgender women report more than double the heart attack rate of cisgender women, while their rate does not differ significantly from cisgender men.
Source: American Heart Association
New analysis finds higher reported heart attack rates among transgender people compared with their cisgender counterparts.
A nationwide study led by researchers at George Washington University and presented at the American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions in Arlington, Virginia, reports elevated rates of myocardial infarction (heart attack) among transgender adults. The paper also appears in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes.
The study used responses from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System collected from 2014 to 2017. Participants were asked whether they identified as transgender and whether they had ever experienced a heart attack. Researchers then compared reported heart attack histories for transgender men and women against cisgender men and women and adjusted the comparisons for common cardiovascular risk factors.
After accounting for age, hypertension, diabetes, high cholesterol, chronic kidney disease, smoking and physical inactivity, the analysis found that transgender men—individuals assigned female at birth who now identify as male—reported a substantially higher prevalence of prior heart attack than cisgender women (7.2 percent versus 3.1 percent). Statistically adjusted models indicated transgender men had more than a fourfold higher odds of reporting a prior myocardial infarction compared with cisgender women and more than twice the odds compared with cisgender men.
Transgender women—individuals assigned male at birth who identify as female—reported more than twice the rate of prior heart attack compared with cisgender women. The study did not find a statistically significant difference in reported heart attack rates between transgender women and cisgender men.
Lead author Tran Nguyen, MD, noted that while prior research has documented higher prevalence of several cardiovascular risk factors among transgender populations—including social determinants such as poverty, higher rates of smoking, and elevated rates of depression—the magnitude of the difference in heart attack reporting surprised the team. The study’s findings underscore the need for more focused clinical attention and research on cardiovascular health in transgender adults.
Cardiology experts emphasize that the study is observational and has limitations that should guide interpretation. For example, the survey data do not indicate timing: whether reported heart attacks occurred before or after an individual began identifying as transgender, how long respondents had identified as transgender, or whether they had received gender-affirming surgeries. The dataset also did not include detailed information about hormone therapy use, which may affect cardiovascular risk and is an important variable in understanding health outcomes for transgender patients.
Experts quoted in response to the study stress two points: first, the analysis is an important step in recognizing potential cardiovascular disparities in gender minority populations; second, larger prospective cohort studies are needed to establish causal pathways and to capture the effects of hormone therapies, duration of transgender identity, surgical history and age-related risk over time.
Because many people who identify as transgender are younger, longer-term follow-up is necessary to fully understand lifetime risk of myocardial infarction and other cardiovascular outcomes.
In the short term, clinicians and patients can use these findings to guide preventive care. Researchers and clinicians recommend that medical teams caring for transgender patients screen carefully for conventional cardiovascular risk factors, have open conversations about lifestyle and mental health, and monitor the potential cardiovascular effects of hormone therapy where applicable. Strengthening primary prevention—such as blood pressure and cholesterol control, diabetes management, smoking cessation and exercise—remains a priority for reducing heart disease risk in all populations, including transgender people.
Source:
American Heart Association
Media Contacts:
Tran Nguyen – American Heart Association
Image Source:
The image is adapted from the American Heart Association news release.
Original Research: Open access
“Cardiovascular Disease Risk Factors and Myocardial Infarction in the Transgender Population” — Talal Alzahrani, MD, MPH; Tran Nguyen, MD; Angela Ryan, MD; Ahmad Dwairy, MD; James McCaffrey, MD; Raza Yunus, MD; Joseph Forgione, MD; Joseph Krepp, MD; Christian Nagy, MD; Ramesh Mazhari, MD; Jonathan Reiner, MD. Circulation: Cardiovascular Quality and Outcomes. DOI: 10.1161/CIRCOUTCOMES.119.005597
Abstract (summary):
As of 2016, an estimated 1.4 million people in the United States identify as transgender. Previous studies have shown higher prevalence of cardiovascular risk factors in transgender populations but were limited by small samples and younger age groups. Using Behavioral Risk Factor Surveillance System data from 2014–2017, this study evaluated associations between transgender status and self-reported history of myocardial infarction after adjusting for established cardiovascular risk factors. Multivariable analysis found that transgender men had a greater than twofold increased odds of reporting prior myocardial infarction compared with cisgender men and approximately a fivefold increase compared with cisgender women. Transgender women had increased odds of reporting prior myocardial infarction compared with cisgender women but did not differ significantly from cisgender men. These results highlight a higher reported history of myocardial infarction among transgender adults and point to the need for further research and targeted prevention efforts.