Lesbian, gay, bisexual veterans face higher odds for prevalent ASCVD vs. straight peers
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Key takeaways:
- Lesbian, gay and bisexual U.S. veterans may have increased odds for prevalent ASCVD.
- Even after accounting for traditional CVD risk factors, this association remained significant.
Lesbian, gay and bisexual U.S. veterans had significantly higher odds for prevalent atherosclerotic CVD compared with their heterosexual peers, according to findings published in the Journal of the American Heart Association.
“Sexual minority adults experience inequities in ASCVD risk and outcomes compared with heterosexual peers,” Carl G. Streed Jr., MD, MPH, associate professor of medicine in the section of general internal medicine at Boston University Chobanian and Avedisian School of Medicine and research lead for the GenderCare Center at Boston Medical Center, and colleagues wrote. “With increasing visibility and acceptance of the sexual minority population, and with projections indicating there will be upward of 7 million lesbian, gay and bisexual (LGB) adults older than 50 years by 2030, assessing and addressing the cardiovascular health of LGB older adults remains a critical priority for LGB patients as well as clinicians, researchers and public health officials.”
To examine the association between sexual orientation and ASCVD outcomes, Streed and colleagues conducted a cross-sectional analysis of data from more than 1.1 million U.S. veterans (mean age, 52 years; men, n = 956,390; white, n = 752,864) who participated in the Veterans Affairs LGBT electronic health record cohort study, a prospective nationwide observation study of 9.5 million veterans with one or more primary care visits in the VA system from October 2009 to September 2019.
The researchers used a natural language processing tool to classify veterans with sufficient EHR data as LGB (n = 170,861) or non-LGB (n = 931,332).
They used ICD-10 codes to identify prevalent ASCVD, defined as history of acute MI, ischemic stroke or revascularization, during the baseline period, which was 1 year after the date of each veteran’s first primary care visit on or after Oct. 1, 2009.
Overall, the researchers found that 25,031 (LGB, n = 4,105) veterans had prevalent ASCVD, 21,147 (LGB, n = 3,471) had ischemic stroke, 2,666 (LGB, n = 454) had MI and 2,609 (LGB, n = 413) had revascularization.
After adjusting for age, sex, race and Hispanic ethnicity, the researchers reported that LGB veterans had 1.24 greater odds for prevalent ASCVD (95% CI, 1.19-1.28) compared with non-LGB veterans
This association remained significant after further adjustment for BMI, estimated glomerular filtration rate, diabetes, hypertension, lipids, substance use, anxiety, depression, HIV and homelessness (OR = 1.17; 95% CI, 1.13-1.21), according to the study.
The association was also significant among a subsample of 333,758 veterans (LGB, n = 19,505) who self-reported their sexual orientation and had natural language processing-defined sexual orientation data (OR = 1.53; 95% CI, 1.2-1.95).
“These results reflect disparate cardiovascular morbidity of sexual minority veterans as well as reveal that even when accounting for inequities in risk factors, sexual minority veterans continue to fair worse than heterosexual peers,” the researchers wrote. “Clinicians and researchers must explore additional factors unique to sexual minority people, such as minority stressors, that affect their risk for ASCVD.”
Streed and colleagues acknowledged several study limitations, including the potential for misclassification of participant sexual identity, selection bias and underreporting and reduced documentation of sexual minority status.
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