Femei trans pe hormoni: de 4,5 ori mai multe cheaguri și mai multe AVC decât bărbații; bărbați trans: mai multe infarcte

Apariția evenimentelor cardiovasculare acute la persoanele transgender care primesc terapie hormonală

Studii de cohortă și registre Hormoni de sex opus

Authors: Nienke M. Nota, Chantal M. Wiepjes, Christel J.M. de Blok, Louis J.G. Gooren, Baudewijntje P.C. Kreukels, Martin den Heijer
Journal: Circulation
Year: 2019
Source: https://doi.org/10.1161/CIRCULATIONAHA.118.038584

Summary

This short report used records from the Amsterdam gender clinic, which treats most trans people in the Netherlands. It counted strokes, heart attacks and blood clots in nearly 3,900 people on cross-sex hormones over about 8 to 9 years, and compared them with expected rates in the general population. Trans women had about 4.5 to 5.5 times the expected rate of blood clots and about twice the expected rate of stroke, and more heart attacks than women (but not men). Trans men had more heart attacks than women but about the same as men. Blood-clot risk was lower, though still raised, in trans women who started after 2001, when an older estrogen was dropped. The long follow-up makes this useful, but the comparison is with outside population figures, smoking was not accounted for, and the trans men's results rest on few events.

Key findings

Studiul a inclus 2.517 femei trans și 1.358 de bărbați trans tratați la clinica de gen din Amsterdam, urmăriți în medie aproximativ 9 și 8 ani.
Femeile trans au avut 73 de cheaguri de sânge în vene: de 5,5 ori rata așteptată la femei și de 4,5 ori cea de la bărbați.
Femeile trans au avut 29 de accidente vasculare cerebrale (de 2,4 ori rata la femei, de 1,8 ori cea de la bărbați) și 30 de infarcte (de 2,6 ori rata la femei; nu mai mari decât la bărbați).
Bărbații trans au avut 11 infarcte: de 3,7 ori rata așteptată la femei și la fel ca cea așteptată la bărbați.
Bărbații trans au avut doar 6 accidente vasculare cerebrale și 2 cheaguri de sânge, fără o diferență clară față de bărbați sau femei.
Excluderea femeilor trans care au început înainte de 2001 (când un estrogen mai vechi, etinilestradiolul, a fost înlocuit) a coborât rata cheagurilor de sânge la aproximativ 3,9 ori cea a femeilor și 3,4 ori cea a bărbaților; celelalte riscuri nu au scăzut.
43–46% dintre persoanele din studiu fumau, iar acest lucru nu a putut fi luat în calcul.

Conclusion

Considering the limitations, the authors conclude that the incidences of strokes and VTEs are higher in transwomen receiving hormone therapy than in both reference women and men, and that transwomen and transmen receiving hormone therapy are at higher risk of myocardial infarction than reference women. They urge physicians and transgender individuals to be aware of this increased cardiovascular risk and to reduce risk factors such as smoking.

Methodological limitations

Very short report: It was published as a two-page letter with few details, so how events were defined, who was left out and how results were checked are only briefly described.
Outside comparison only: Rates were compared with figures from separate Dutch and Norwegian population studies that found cases in different ways, not with a matched group of similar people.
Other risk factors ignored: The authors could not account for smoking (43–46% smoked) or life stresses, and weight, diabetes and other risk factors were not accounted for either.
Events may have been missed: Events were found by searching clinic files for doctors' letters. Events treated elsewhere and not reported back may have been missed, so true rates are probably higher.
Older drugs: Much of the follow-up involved older drugs (ethinylestradiol and high-dose cyproterone). Leaving out early starters lowered blood-clot risk, so the headline figure overstates risk on today's drugs, though risk was still raised.
Few events in trans men: Results rest on 6 strokes, 11 heart attacks and 2 blood clots, so the figures are very uncertain.
Some people left out: People who stopped hormones for long periods or switched between male and female hormones (such as some detransitioners) were excluded, as were 52 people with a past event.
Uneven follow-up: The typical person was followed for only about 4 to 6 years, much less than the average, so much of the data comes from a minority treated for a long time.
One clinic: Everyone was treated at one specialist centre, so results may not apply outside the Netherlands.

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Summary

Key findings

Conclusion