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Transgender people have unaddressed heart disease risks

Presented by
Dr Kara Denby, Cleveland Clinic, USA
AHA 2020
A retrospective study of transgender people using gender-affirming hormone therapy (GAHT) found excessive undiagnosed hypertension and hyperlipidaemia, suggesting that these individuals should be monitored for heart disease risk [1].

Dr Kara Denby (Cleveland Clinic, USA) presented the study aiming to identify the baseline cardiovascular risk of transgender individuals presenting for gender-affirming care from a multidisciplinary transgender programme. Transgender people were included if they had not yet initiated GAHT. Collected data included demographics, medical history, vitals, medications, and laboratory results. The ACC/AHA ASCVD and QRISK3 CV risk scores were calculated for all participants without documented CV disease.

Included were 427 participants. Their mean age was 26 years, mean BMI was 29.3 kg/m2. Sex assigned at birth was 238 (55.6%) male, 186 (43.5%) female, and 4 (0.9%) intersex. Gender was 172 (40.2%) men, 236 (55.1%) women, and 20 (4.7%) non-binary. Of the subjects, 237 (55.4%) had a chronic medical condition. The incidence of undiagnosed hypertension and hyperlipidaemia was 6.8% and 11.3%, respectively; of these cases, only 64.4% and 24.1% were on appropriate therapies. Mean ASCVD risk and QRISK3 for ages 40–65 was 8.3% and 12.2%, respectively. Mean QRISK for ages 25–39 was 4.6%. Among participants who fell into intermediate- or high-risk categories, very few had a history of statin use.

The researchers concluded that transgender individuals presenting for GAHT have an elevated CV risk, including high rates of undiagnosed and untreated CV risk factors with inadequate prevention, compared with age-matched historical cohorts regardless of gender. Further research is warranted into this unmet need in the transgender population.

    1. Denby K, et al.l. Cardiovascular Risk at Presentation for Gender-Affirming Care in the Transgender Population. P2274, AHA Scientific Sessions 2020, 13–17 Nov.


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