CVD events infrequent, but higher in transgender vs. cisgender individuals
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Although incidence was low, transgender individuals in Sweden experienced higher CVD incidence compared with cisgender controls from the country’s general population, researchers reported.
The most prevalent CVD event among transgender individuals was conduction disorders, a novel finding, according to the researchers.
Additionally, risk for any CVD event among transgender individuals was not different in those who underwent gender-affirming hormone therapy compared with those who did not, according to data published in the European Journal of Preventive Cardiology.
“Over the last decades, there is increasing interest regarding potential adverse health outcomes among transgender individuals, with special focus on cardiovascular outcomes,” Maria A. Karalexi, PhD, affiliated researcher in the department of women’s and children’s health, obstetric and reproductive health research at Uppsala University in Sweden, and colleagues wrote. “Previous studies in assigned female at birth individuals suggest that testosterone therapy might increase lean mass and decrease fat mass without affecting insulin resistance, whereas studies in assigned male at birth individuals suggest that estrogen therapy decreases lean mass and increases fat mass, which might therefore lead to insulin resistance, which is a risk factor for cardiovascular disease.”
CVD events in transgender vs. cisgender individuals
Researchers undertook the present study to assess the incidence of CVD among transgender individuals, with and without gender-affirming hormone therapy, compared with its incidence among cisgender individuals in the general population.
Using Swedish nationwide health care registers, 1,779 transgender individuals were identified, of whom 48% were assigned male at birth and 52% were assigned female at birth.
Researchers also stratified transgender individuals by those with a diagnosis of gender dysphoria with and without initiating gender-affirming hormone therapy.
The mean age of transgender individuals assigned female at birth was 26 years and was 31 years among those assigned male at birth.
Transgender individuals included in this analysis had similar rates to cisgender individuals for prescription of hypertension, hyperlipidemia and diabetes therapies.
The incidence of any psychiatric diagnosis was more than twofold among transgender compared with cisgender individuals.
Eighteen transgender individuals developed CVD during follow-up (1,069 person-years).
Four transgender individuals assigned female at birth experienced conduction disorders.
Fourteen transgender individuals assigned male at birth experienced at least one CVD event during follow-up:
- three major adverse CV events;
- nine conduction disorders;
- three cerebrovascular events;
- three thrombotic events; and
- three CVD deaths.
The incidence of CVD was 3.7 per 1,000 person-years among transgender individuals assigned female at birth and 7.1 per 1,000 person-years among those assigned male at birth compared with 1.9 per 1,000 person-years among cisgender women and 1.7 per 1,000 person-years among cisgender men, according to the study.
Researchers reported a more than twofold greater risk for any CVD event among transgender individuals assigned male at birth compared with cisgender women (HR = 2.4; 95% CI, 1.3-4.2) and a slightly greater risk compared with cisgender men (HR = 1.7; 95% CI, 0.95-2.9).
The CVD driving this elevated risk was identified to be occurrence of conduction abnormalities.
The researchers found no greater risk for any CVD event among transgender individuals who underwent gender-affirming hormone therapy compared with transgender individuals who did not.
‘One novel finding’ in conduction abnormalities
“One novel finding is the increased incidence of conduction disorders among transgender individuals,” the researchers wrote. “Sex hormone levels in individuals receiving gender-affirming hormone therapy may be comparable to those of cisgender persons. Thus, it is biologically plausible that exogenous hormonal therapies alongside the acquired endogenous sex hormone levels in transgender individuals can alter the clinical penetrance of cardiac pro-arrhythmia phenotypes.
“The potential mechanisms that may explain the association between gender dysphoria and CVD outcomes, if causal, seem to be multifactorial. In particular, increased social stress, health disparities, poor socioeconomic status, substance abuse and psychiatric comorbidities, all known risk factors for CVD, are frequently reported in this population,” the researchers wrote. “These factors are challenging to adjust for methodologically.”