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Trans muži hlásili infarkty 4,9krát častěji než ženy v americkém průzkumu – ale užívání hormonů se nikdy neměřilo

Rizikové faktory kardiovaskulárních onemocnění a infarkt myokardu v transgenderové populaci

DotazníkyHormony opačného pohlaví
Authors
Talal Alzahrani, Tran Nguyen, Angela Ryan, Ahmad Dwairy, James McCaffrey, Raza Yunus, Joseph Forgione, Joseph Krepp, Christian Nagy, Ramesh Mazhari, Jonathan Reiner
Journal
Circulation: Cardiovascular Quality and Outcomes
Year
2019
Source
https://doi.org/10.1161/CIRCOUTCOMES.119.005597

Summary

Heart doctors at George Washington University analysed four years of a large US government health phone survey that asks about gender identity. Transgender people more often said they had ever had a heart attack. After allowing for standard risk factors, trans men reported one about 2.5 times as often as non-trans men and nearly 5 times as often as non-trans women. Trans women reported one more often than non-trans women, but not more than men. The survey does not ask about hormone treatment, when people transitioned, or when the heart attack happened. So the study cannot show that hormones, or anything else, caused the difference. It is an early warning sign worth investigating, and fits later studies that followed people over time and found more heart attacks in trans men than in women. It is not proof of cause.

Key findings

  • Studie využila čtyři roky (2014–2017) státem vedeného amerického zdravotního telefonického průzkumu, který zahrnuje volitelné otázky o genderové identitě.
  • Před úpravou uvedlo 7,2 % trans mužů a 7,8 % trans žen, že prodělalo infarkt, oproti 5,6 % netrans mužů a 3,1 % netrans žen.
  • Po zohlednění věku a standardních rizikových faktorů srdce měli trans muži asi 2,5krát vyšší pravděpodobnost než netrans muži a asi 4,9krát vyšší než netrans ženy, že infarkt uvedou. Skutečná velikost těchto rozdílů je velmi nejistá.
  • Trans ženy měly asi 2,5krát vyšší pravděpodobnost než netrans ženy, že infarkt uvedou, ale ve srovnání s netrans muži nebyl zřetelný rozdíl.
  • Průzkum nemá informace o tom, zda lidé užívali hormony opačného pohlaví nebo jak dlouho, takže zjištění nelze připsat hormonům.
  • Úvodník zveřejněný spolu se studií (Chan, 2019) označil výsledky za „v nejlepším případě vytvářející hypotézy“, protože nikdo neví, zda infarkty nastaly před tranzicí, nebo po ní.

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.

Conclusion

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. The authors speculate that minority stress and hormone therapy may contribute.