Transgender men and women may have higher heart attack risk

AHA news: transgender men and women may have higher heart attack risk

A new study indicates transgender men and women have a higher risk of heart attack—more than four times in some instances—than people who identify as the gender with which they were born.

The findings are being presented Friday at the American Heart Association's Quality of Care and Outcomes Research Scientific Sessions in Arlington, Virginia. The George Washington University-led study also appears in the AHA journal Circulation: Cardiovascular Quality and Outcomes.

"This has not been a topic that has been discussed a lot in the past," said Dr. Tran Nguyen, one of the study's principal authors.

"But previous studies have shown that the transgender population has been more prone to more cardiovascular risk factors, such as poverty, smoking … and depression," said Nguyen, an resident at George Washington University School of Medicine and Health Sciences in Washington, D.C. "What surprised us was that the rate of attacks would be that much higher."

A 2016 analysis by the Williams Institute at the UCLA School of Law estimated about 1.4 million Americans identify as transgender.

The researchers analyzed data spanning 2014-2017 from a nationwide health survey by the Centers for Disease Control and Prevention.

Among the questions were whether respondents had ever had a and whether they classified themselves as transgender.

Even after adjusting for such as age, , diabetes and lack of exercise, transgender men (who were born biologically female but now identify as male) had more than four times the rate of heart attack as cisgender women (who were born biologically female and identify as female)—7.2 percent compared with 3.1 percent. Transgender men also had more than twice the rate of heart attack as cisgender men (who were born biologically male and identify as male).

Transgender women (who were born biologically male and identify as female) had more than twice the rate of heart attack as cisgender women. There was no significant difference in heart attack rates for transgender women and cisgender men.

"We need more research about causation," Tran said. "But I hope this will bring awareness to both the and the transgender population."

Dr. Paul Chan, a cardiologist and professor at the University of Missouri-Kansas City School of Medicine, agreed. But he deemed the study preliminary, for many reasons.

"It begins the conversation and that's the important thing," said Chan, who was not involved in the study. "But it's an observational study, and that is very limited."

For example, Chan said, the survey did not ask how long the subject had identified as transgender, whether the heart attack occurred before or after changing gender identification, and whether the subjects had undergone gender reassignment surgery.

Most importantly, he said, the survey did not include data about hormone therapy—testosterone for and estrogen for transgender women—which has been linked to increased risk of heart disease.

In addition, "The majority of population reporting as transgender are younger, so the true risk of heart attack may not be known for years," Chan said.

"We need large cohort studies to follow up," he said, referring to research that establishes links between risk factors and health outcomes. "And we need to think about how we design gender questions, not just perpetuate the issue as binary because we only give two options. That will give us a lot more data about risks and benefits."

In the meantime, Nguyen said, patients and their doctors need to be especially vigilant in controlling other risk factors for heart disease.

"They need to have open conversations about this," she said, "so we can decrease the risk in this population."

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American Heart Association News covers heart and brain health. Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved. If you have questions or comments about this story, please email

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Apr 07, 2019
One wonders if there has been an increase in homosexuality and gender mismatch in recent years and if this might be caused by environmental factors...

"...endocrine disruptors may pose the greatest risk during prenatal and early postnatal development when organ and neural systems are forming..."

-or adverse maternal epigenetic influences due to diet, drug, tobacco or alcohol use, sedentarism, chronic infection or inflammation, or even the perception of overcrowding.

Per the latter, many species have biological mechanisms to counter overcrowding. Rabbits will begin absorbing fetuses in overcrowded warrens, for instance.

And as humans have lived with endemic overcrowding through the entire existence of the species, we should expect to find similar such mechanisms in their biology. Gender shifts which reduce the possibility of reproducing might be one.

We might suspect eating disorders and addictions as well as cultural expressions such as infanticide and abortion.

Apr 07, 2019
But one also wonders if funding could ever be secured to conduct studies in this area, or if there would even be the desire to do so within academie communities, given their concerted effort to normalize all the gender varieties real and/or contrived.

This effort belies their true role as modifiers rather than explainers of human behavior. If they were truly objective they would be trying to find out the cause of gender variation rather than merely excusing and legitimizing it.

Sex is one half of a whole thing - reproduction. The desire for sex is the desire to reproduce. That's ALL it is. The REASON sex is so pleasurable is because it's so important. Any attempts to separate sex from the act of making more human beings, are cultural expedients most commonly intended to modulate the birthrate.

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