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Uomini trans: infarti riferiti 4,9 volte più delle donne in un sondaggio USA, ma ormoni non misurati

Fattori di rischio cardiovascolare e infarto miocardico nella popolazione transgender

SondaggiOrmoni cross-sex
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

  • Lo studio ha usato quattro anni (2014–2017) di un sondaggio telefonico sulla salute gestito dagli stati degli Stati Uniti che comprende domande facoltative sull'identità di genere.
  • Prima della correzione, il 7,2% degli uomini trans e il 7,8% delle donne trans ha detto di aver avuto un infarto, contro il 5,6% degli uomini non trans e il 3,1% delle donne non trans.
  • Tenendo conto dell'età e dei fattori di rischio cardiaco standard, gli uomini trans avevano una probabilità circa 2,5 volte maggiore degli uomini non trans, e circa 4,9 volte maggiore delle donne non trans, di riferire un infarto. L'entità reale di queste differenze è molto incerta.
  • Le donne trans avevano una probabilità circa 2,5 volte maggiore delle donne non trans di riferire un infarto, ma non c'era una differenza chiara rispetto agli uomini non trans.
  • Il sondaggio non ha informazioni sul fatto che le persone assumessero ormoni cross-sex né per quanto tempo, quindi i risultati non possono essere attribuiti agli ormoni.
  • Un editoriale pubblicato insieme allo studio (Chan, 2019) ha definito i risultati «generatori di ipotesi, nella migliore delle ipotesi», perché nessuno sa se gli infarti siano avvenuti prima o dopo la transizione.

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.