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

• 이 연구는 성 정체성에 대한 선택 질문이 포함된 미국 주 운영 건강 전화 조사의 4년치(2014~2017년)를 사용했습니다.
• 보정 전에는 트랜스 남성의 7.2%와 트랜스 여성의 7.8%가 심장마비를 겪었다고 말했는데, 비트랜스 남성은 5.6%, 비트랜스 여성은 3.1%였습니다.
• 나이와 표준적인 심장 위험 요인을 고려한 뒤, 트랜스 남성은 비트랜스 남성보다 약 2.5배, 비트랜스 여성보다 약 4.9배 심장마비를 보고할 가능성이 높았습니다. 이 차이의 실제 크기는 매우 불확실합니다.
• 트랜스 여성은 비트랜스 여성보다 약 2.5배 심장마비를 보고할 가능성이 높았지만, 비트랜스 남성과 비교했을 때는 뚜렷한 차이가 없었습니다.
• 조사에는 사람들이 반대 성 호르몬을 썼는지 또는 얼마나 오래 썼는지에 대한 정보가 없으므로, 결과를 호르몬 탓으로 돌릴 수 없습니다.
• 함께 실린 사설(Chan, 2019)은 심장마비가 전환 전에 일어났는지 후에 일어났는지 아무도 모르기 때문에 결과를 ‘기껏해야 가설 생성적’이라고 불렀습니다.

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.