Trans adults in rural areas at higher risk of cardiovascular disease

Transgender adults living in rural Appalachia are at higher risk for cardiovascular disease than cisgender people, new research shows.

Medical Xpress reported on a new study that looked at 89 transgender adults and 69 randomly selected cisgender people living in Huntington, West Virginia and neighboring areas of rural Ohio and Kentucky between November 2022 and February 2023. It found that trans participants were more likely to have cardiovascular disease risk factors like tobacco use, obesity, and high blood pressure.

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LGB adults are at a higher risk for heart disease. They may not be aware of how to prevent it.

Experts expressed an “urgent need for tailored interventions and campaigns” that promote awareness among the LGB community.

The study’s lead author, Ebubechukwu Ezeh, explained that research has already shown an increased risk of cardiovascular disease among transgender people across the U.S., as well as disproportionate cardiovascular disease and associated risk factors in rural areas.

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“Data indicates that West Virginia, which is wholly in the Appalachian region, has one of the highest per capita rates of transgender youth in the country, so we sought to study the burden of cardiovascular disease risks in the transgender population in this region,” Ezeh explained.

Trans participants in the study were more than six times more likely to use tobacco and almost four times more likely to have prediabetes or Type 2 diabetes, Medical Xpress reports. While cisgender participants were just slightly more likely to experience obesity than trans participants, trans men were 13 times more likely to experience obesity than trans women. They were also nearly 3.5 times more likely to have high cholesterol than trans women.

While the study found that trans participants who received gender-affirming surgery or hormone treatments were 11 times more likely to use alcohol, six times more likely to use tobacco, and four times more likely to need cholesterol-lowering medications, the sample size limits the generalization of these findings, Medical Xpress notes.

The study’s findings, Ezeh said, highlight the importance of identifying the needs of trans individuals and addressing them by developing interventions.

“With these findings, we can intentionally work towards improving the overall health and well-being of transgender individuals and reducing their cardiovascular risk,” Ezeh said.

He added that because participants in the study were relatively young — the average age of both trans and cis participants was 29 —researchers believe that early interventions may reduce the risk of cardiovascular-related death.

Ezeh also suggested that more comprehensive assessments of the effects of different hormone therapy regimens on cardiovascular health are needed and that future research should include larger studies of transgender people.

Carl Streed Jr., an assistant professor of internal medicine at Boston University School of Medicine and the research lead at the GenderCare Center at Boston Medical Center, told Medical Xpress that the study’s findings highlight both the potential increased cardiovascular risk among transgender people and the increased cardiovascular risk among people living in rural areas.

“These disparity gaps pack a one-two punch to our transgender patients and communities for a number of reasons,” Streed said. “The physical risks are likely heightened by the mental stress that many LGBTQ+ people encounter due to discrimination that is often more prevalent in rural America, especially among states with policies limiting access to gender affirming care. The American Heart Association supports the need for more research and initiatives to ensure equitable health and health care for all people, especially persons and communities most at risk due to various diversity gaps in care whether they are based on racial, ethnic, sexual and/or gender identities, socioeconomic status or geography.”