Discrimination, stress related to poorer heart health in transgender and diverse adults

The stress of discrimination in a variety of ways, including transphobia, interpersonal discrimination, violence, and public policies specifically targeted at transgender and diverse people (TGD), is associated with higher rates of heart disease among the population. of TGD, according to a new scientific statement from the American Heart Association, published today in TGD Circulation. A scientific statement is an expert analysis of current research and can report on future guidelines.

The statement, which assesses and treats cardiovascular health in transgender and diverse people, examines existing research on TGD-specific cardiovascular Health disparities, identifies research gaps, and provides suggestions for systematically improving globally color health and care of people TGD. The group drafting statements suggests that improving overall heart health in the TGD community will require a multidisciplinary approach that includes health professionals, educators, researchers, and policymakers.

In terms of health, transgender, diverse gender, and nonconforming people are considered to be “gender minorities”. Extending the theory of minority stress, group members who drafted statements documented how chronic levels of stress faced by members of stigmatized and underrepresented populations are associated with poor health outcomes and disparities. of health. They concluded that higher rates of cardiovascular prevalence and deaths among people with TGD, despite being related to traditional cardiovascular risk factors, are also significantly driven by lifelong psychosocial stressors at various levels, including structural violence, discrimination, lack of affordable housing and access to health care. care.

“The heart health of transgender and diverse people is an important and little-studied topic, and it is critical that we highlight what we know and what we need to know about heart health among these populations,” said Carl G. Streed, Jr., MD, MPH, chairman of the statement drafting group, assistant professor of internal medicine at Boston University School of Medicine and principal investigator of the Center for Transgender Medicine and Surgery at Boston Medical Center. “To address these issues will need to focus on the ‘traditional’ risk factors for heart attack and stroke and a commitment to combat transphobia to decrease the additional stress experienced by this population.”

This statement, specific to TGD people, is based on the Association’s 2020 scientific statement, which assesses and treats cardiovascular health in lesbian, gay, bisexual, transgender, and queer (or questioning) adults, noting that more than half (56%) of LGBTQ adults and 70% of those who are transgender or non-gender compliant have reported experiencing some form of discrimination by a health care professional.

The new statement notes that a growing group of research indicates that populations of TGD may have a significantly higher risk of developing cardiovascular disease compared to their cisgender peers. Transgender men are twice as likely to suffer a heart attack as cisgender men and four times more likely than cisgender women. People with TGD are also more likely to experience blood clots when undergoing estrogen hormone therapy. The drafting group notes that urgent research is needed to explain these disparities.

TGD populations also face unique psychological stressors, including non-gender assertion (e.g., being called with an incorrect pronoun), discrimination, rejection, or concealment of gender identity, and violence. based on gender identity. These factors contribute to higher overall stress levels which in turn negatively affect heart health. In addition, TGD people who are also part of historically excluded racial or ethnic groups experience multiple layers of stress, such as lower income levels or limited access to health care. Research on how these complex and intertwined factors affect heart health in TGD populations is limited.

Most gender identification options in a clinical or research setting include only “male” and “female,” so although population-based studies can help understand some aspects. cardiovascular health risk factors, data on TGD people are scarce. The statement suggests that studies should standardize measures of gender identity and expression to collect larger samples from underrepresented groups among TGD populations.

Data collected through electronic health records (EHRs) present a breakthrough in terms of data access, although EHRs often lack the ability to capture sociocultural factors relevant to cardiac health among TGD people. It is important to note that TGD people who do not have regular access to health care services are less likely to be included in EHR data, and TGD people who do not feel comfortable revealing their gender identity to health professionals it is unlikely to be identified as TGD in EHR systems.

While the need to document sexual orientation and gender identity has been necessary for electronic health records since 2018, additional steps are needed to ensure cultural and supportive care. The statement details the critical need for researchers and physicians to use pronouns that affirm gender and obtain an anatomy inventory, if any, noting that assumptions about a person’s identity or anatomy TGD they can negatively affect clinical decisions.

The drafting group suggests that further training among the health professions would improve clinical practices and encourage more compassionate care for TGD people. Although many institutions recognize the need for educational content of TGD, efforts to include these topics in clinical curricula have not progressed. The statement suggests that a collaborative effort is needed with mandates at the organizational level in all governing bodies to create a curriculum that includes gender-affirming hormone therapy, surgical procedures, preventive health based on the anatomy, social determinants of health and proper assessment of sex and gender in health care parameters.

While the statement emphasizes that existing data is limited, it reviews research on disparities among TGD people in relation to the American Heart Association’s Life’s Simple 7 to measure ideal heart health and how hormone therapy works. can affect the heart health of people with TGD. Current research on blood pressure, lipid profiles, or blood sugar levels for people with TGD is too sparse and inconclusive, although the group of writers suggests several areas of Life’s Simple 7 that are directly related to seizures. heart and stroke. The evaluation of the existing research found:

• TGD people (24%) are more likely to report tobacco use than the rest of the American population (18%).
• Transgender men are less likely to exercise, especially in old age.
• People with TGD who undergo gender-based hormone therapy are more physically active, which may be due to them reporting that they are more satisfied with their body.
• TGD youth report that they eat more fast food and use unsafe ways to try to control weight (e.g., diet pills, fasting, or laxative abuse).
• People with TGD have a generally higher body mass index (BMI), although they may experience additional stress due to their weight, as many surgeons have strict BMI guidelines above which they will not perform surgeries that claim gender. .

“Discrimination also contributes to disparities in the social determinants of health between TGD populations and many people with TGD have an even greater risk of suffering from heart disease and stroke due to transphobia and experiences of discrimination based on gender nonconformity, ”said Lauren B. Beach, Ph.D., JD, vice president of the statement writing group and assistant professor of research in the medical sciences department at the Feinberg School of Medicine. Northwestern University of Chicago. “Systematic transphobic discrimination causes a greater burden of discrimination in the workplace, loss of employment and unemployment among TGD populations. Combined with experiences of discrimination in health settings, lack of access to a stable income further limits access to health care among people with TDD These structural factors combine to simultaneously lead to higher levels of chronic stress and lower levels of resources to prevent or control a wide variety of health conditions, including disease. cardiovascular. “

The drafting group also cited studies showing that TGD people experience disproportionate burdens of additional cardiovascular risk factors, such as living with HIV, vascular dysfunction, trouble sleeping, and alcohol abuse.

The drafting group recognizes limited data and encourages additional research to understand the many and complex issues facing TGD people and as a community. The statement highlights available information that illustrates that TGD people often experience challenges due to unique stressors, including the internalization of gender identity, sexual victimization, and concerns about hormone therapies and surgeries they claim. the genre.

“Still, specific data on transgender and gender people lags behind what is needed to understand and improve individual and community heart health. The information available is improving rapidly,” Streed said. “This statement summarizes the available evidence showing that addressing traditional cardiovascular risk factors and decreasing stigma-related stress will improve the heart health of people with TGD. By focusing on the unique issues that affect well-being of transgender i genre diverse people, we have the potential to do better for everyone. ”