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美國調查中，跨性別男性報告心臟病發作的比率是女性的4.9倍——但從未測量荷爾蒙使用情況

跨性別人群的心血管疾病危險因子與心肌梗塞

問卷調查跨性激素治療
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

  • 研究使用了美國一項由州政府進行的健康電話調查四年（2014–2017）的資料，其中包含關於性別認同的選答問題。
  • 調整前，7.2% 的跨性別男性和 7.8% 的跨性別女性表示曾心臟病發作，而非跨性別男性為 5.6%，非跨性別女性為 3.1%。
  • 在考慮年齡和標準的心臟風險因素後，跨性別男性回報心臟病發作的可能性約為非跨性別男性的 2.5 倍，約為非跨性別女性的 4.9 倍。這些差異的真實大小非常不確定。
  • 跨性別女性回報心臟病發作的可能性約為非跨性別女性的 2.5 倍，但與非跨性別男性相比沒有明顯差異。
  • 調查沒有關於人們是否使用跨性別荷爾蒙或使用多久的資訊，因此這些發現不能歸咎於荷爾蒙。
  • 同期刊出的社論（Chan，2019）稱這些結果「最多只能產生假說」，因為沒有人知道心臟病發作是在過渡之前還是之後。

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.