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Transmannen meldden 4,9 keer vaker een hartaanval dan vrouwen in VS-enquête, maar hormoongebruik werd niet gemeten

Risicofactoren voor hart- en vaatziekten en myocardinfarct in de transgenderpopulatie

EnquêtesCross-sekse hormonen
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

  • De studie gebruikte vier jaar (2014–2017) van een Amerikaanse, door staten uitgevoerde telefonische gezondheidsenquête met optionele vragen over genderidentiteit.
  • Vóór correctie zei 7,2% van de transmannen en 7,8% van de transvrouwen een hartaanval te hebben gehad, tegenover 5,6% van de niet-trans mannen en 3,1% van de niet-trans vrouwen.
  • Na rekening te houden met leeftijd en standaard hartrisicofactoren hadden transmannen ongeveer 2,5 keer zoveel kans als niet-trans mannen, en ongeveer 4,9 keer zoveel kans als niet-trans vrouwen, om een hartaanval te melden. De werkelijke omvang van deze verschillen is zeer onzeker.
  • Transvrouwen hadden ongeveer 2,5 keer zoveel kans als niet-trans vrouwen om een hartaanval te melden, maar er was geen duidelijk verschil vergeleken met niet-trans mannen.
  • De enquête heeft geen informatie over de vraag of mensen cross-sex hormonen gebruikten of hoe lang, dus de bevindingen kunnen niet aan hormonen worden toegeschreven.
  • Een redactioneel commentaar dat erbij werd gepubliceerd (Chan, 2019) noemde de resultaten 'hooguit hypothesegenererend', omdat niemand weet of de hartaanvallen vóór of na de transitie plaatsvonden.

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.