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

• 该研究使用了美国一项州一级健康电话调查四年（2014至2017年）的数据，其中包括关于性别认同的可选问题。
• 调整前，7.2%的跨性别男性和7.8%的跨性别女性说自己发生过心脏病发作，而非跨性别男性为5.6%，非跨性别女性为3.1%。
• 考虑年龄和标准的心脏风险因素后，跨性别男性报告心脏病发作的可能性约为非跨性别男性的2.5倍，约为非跨性别女性的4.9倍。这些差异的真实大小非常不确定。
• 跨性别女性报告心脏病发作的可能性约为非跨性别女性的2.5倍，但与非跨性别男性相比没有明显差异。
• 该调查没有关于人们是否使用跨性别激素或使用多久的信息，因此这些发现不能归咎于激素。
• 同期发表的一篇社论（Chan，2019年）称这些结果“充其量只是提出假设”，因为没有人知道心脏病发作发生在过渡之前还是之后。

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.