#Many transgender people who receive hormone therapy have unaddressed heart disease risks

Many transgender people who receive gender-affirming hormone therapy already have unaddressed heart disease risk factors such as high blood pressure and high cholesterol, even during young adulthood, according to preliminary research to be presented at the American Heart Association’s Scientific Sessions 2020.

“Previous research has shown that transgender individuals are less likely to have access to health care or to utilize health care for a variety of reasons, including stigma and fear of mistreatment,” said Kara J. Denby, M.D., lead study author and a clinical fellow in cardiovascular medicine at the Cleveland Clinic Foundation in Cleveland, Ohio. “Since transgender individuals have frequent physician visits while taking hormone therapy, this seems an opportune time to screen for cardiovascular risk factors and treat previously undiagnosed cardiovascular disease that can lead to poor health outcomes in the future.”

The researchers examined risk factors and medical history for more than 400 adults (56% assigned male sex at birth, mostly in their 20s and 30s) when they first sought care at the multidisciplinary transgender program at the Cleveland Clinic Foundation.

For participants without current heart disease, two scoring systems were used to estimate their risk of developing heart disease. The researchers found: 6.8% had undiagnosed high blood pressure; and 11.3% had undiagnosed high cholesterol.

Of those already diagnosed with high blood pressure, more than one-third had not been receiving recommended treatment. And, of those already diagnosed with high cholesterol, more than three-quarters had not been receiving recommended treatment.

“When we calculated the risk for developing a heart attack or stroke over 10 years, the risk for transgender men and women was higher than that reported for the average American of their age and gender. We also found that, even in the highest risk individuals, many were not receiving recommended treatment,” said Denby.

In addition, the researchers found that more than half of the study participants (56.5%) had been previously diagnosed with a mental health disorder such as anxiety or depression, which is also associated with increased risk of heart disease.

“Transgender individuals face numerous barriers and biases to access the health care they need. We owe it to them to improve access and care so they can improve their CVD health and overall well-being. Policies and health care structures that are safe and supportive are critical for the transgender population to achieve health equity,” Denby said.

The study, however, is limited by being a retrospective review of medical records. The results cannot be used to prove a cause-and-effect relationship between being transgender and the presence of heart disease risk factors.

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