A retrospective study of transgender people using gender-affirming hormone therapy (GAHT) found excessive undiagnosed hypertension and hyperlipidemia, suggesting that these individuals should be monitored for heart disease risk.

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 program. The transgender population is rapidly growing, yet these individuals often have decreased access to and/or utilization of healthcare. Transgender individuals (n=427) 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 cardiovascular risk scores were calculated for all participants who did not have documented cardiovascular disease.

Of the subjects, 237 (55.4%) had a chronic medical condition. The incidence of undiagnosed hypertension and hyperlipidemia was 6.8% and 11.3%, respectively, and 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 cardiovascular risk, including high rates of undiagnosed and untreated cardiovascular 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. Cardiovascular Risk at Presentation for Gender-Affirming Care in the Transgender Population. P2274, Virtual AHA Scientific Sessions 2020, 13-17 Nov.