Transgender men and women face elevated MI risks

  • Alzahrani T & al.
  • Circ Cardiovasc Qual Outcomes
  • 1 Apr 2019

  • International Clinical Digest
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Takeaway

  • Transgender men and women had higher risk for myocardial infarction (MI) than cisgender counterparts in this cross-sectional study of national survey data.
  • Transgender women vs cisgender men was the only exception among the comparisons.
  • Editorial discusses transgender invisibility, health disparities, many remaining unknowns; calls for long-term cohort studies.

Why this matters

  • Most cardiovascular research assumes gender binary.
  • Numbering 1.4 million, the US transgender population faces social stressors, health problems, substance abuse, low socioeconomic status.
  • Recent meta-analysis finding low MI rates among transgender people using hormones addressed relatively young population.

Key results

  • Mean ages: transgender men, 51.4 years; transgender women, 53.1 years.
  • MI ORs (95% CIs) in logistic regression models:
    • Transgender women vs cisgender women: 2.56 (1.78-3.68; P<.01>
    • Transgender women vs cisgender men: no significant difference.
    • Transgender men vs cisgender men: 2.53 (1.14-5.63; P=.02).
    • Transgender men vs cisgender women: 4.90 (2.21-10.90; P<.01>

Study design

  • Cross-sectional study of Behavioral Risk Factor Surveillance System, 2014-2017, which does not assume gender binary (n=1,842,439). 
  • Outcome: associations between gender identity and MI odds.
  • Models adjusted for age, diabetes, chronic kidney disease, smoking, hypertension, hypercholesterolemia, exercise.
  • Funding: None disclosed.

Limitations

  • Causation not established.
  • No data on hormone therapy, psychosocial factors, timing of MI.
  • Potential recall bias.