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

• המחקר השתמש בארבע שנים (2014–2017) של סקר בריאות טלפוני שמנוהל על ידי מדינות בארה"ב וכולל שאלות אופציונליות על זהות מגדרית.
• לפני התאמה, 7.2% מהגברים הטרנס ו-7.8% מהנשים הטרנס אמרו שהיה להם התקף לב, לעומת 5.6% מהגברים שאינם טרנס ו-3.1% מהנשים שאינן טרנס.
• לאחר התחשבות בגיל ובגורמי סיכון סטנדרטיים ללב, גברים טרנס היו בסבירות גבוהה פי 2.5 בערך מגברים שאינם טרנס, ובערך פי 4.9 מנשים שאינן טרנס, לדווח על התקף לב. הגודל האמיתי של הבדלים אלה אינו ודאי כלל.
• נשים טרנס היו בסבירות גבוהה פי 2.5 בערך מנשים שאינן טרנס לדווח על התקף לב, אך לא היה הבדל ברור בהשוואה לגברים שאינם טרנס.
• בסקר אין מידע אם אנשים נטלו הורמונים של המין השני או למשך כמה זמן, ולכן אי אפשר להאשים את ההורמונים בממצאים.
• מאמר מערכת שפורסם לצדו (Chan, 2019) כינה את התוצאות 'מייצרות השערות במקרה הטוב', מפני שאיש אינו יודע אם התקפי הלב קדמו למעבר או באו אחריו.

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.