Transgender adults in rural America may have more risks for cardiovascular disease

Transgender adults in rural America may be more likely to develop risk factors – including obesity, high blood pressure and diabetes – that can lead to cardiovascular disease and death than their non-transgender peers, new research suggests.

The findings are the latest in a growing body of evidence that underscores the need for stronger health interventions that help reduce disparities that many transgender individuals face, particularly in rural areas, that make them more at risk for heart disease and other cardiovascular conditions. The new research will be presented Sunday at the American Heart Association's Scientific Sessions conference in Philadelphia. The findings are considered preliminary until full results are published in a peer-reviewed journal.

"With these findings, we can intentionally work towards improving the overall health and well-being of transgender individuals and reducing their cardiovascular risk," the study's lead researcher, Dr. Ebubechukwu Ezeh, said in a news release. He is a cardiovascular disease fellow at the University of Kansas in Kansas City. "Because our study population is relatively young, we believe that early intervention may reduce the future risks of death from cardiovascular causes."

The study included 89 self-reported transgender adults and 69 randomly selected non-transgender, or cisgender, individuals who lived in Huntington, West Virginia, and neighboring rural areas of Ohio and Kentucky between November 2022 and February 2023. The participants in both groups were 29 years old on average.

Researchers found that transgender participants had more than six times higher odds of using tobacco and were about four times more likely to have prediabetes or Type 2 diabetes than cisgender participants.

Compared to transgender women, transgender men were 13 times more likely to have obesity and more than three times more likely to have high cholesterol.

The findings also suggest that transgender participants who received gender-affirming surgery or hormone treatments were more likely to use tobacco, consume alcohol and need cholesterol-lowering medications than other transgender participants.

Researchers said the study's small size limits the generalization of the findings. Ezeh called for larger studies of transgender people and more comprehensive assessments of the effects of different hormone therapy regimens on cardiovascular risks.

The new research is of vital concern because it sheds light not only on the potential increased cardiovascular risk to transgender people but also to people living in rural areas, Dr. Carl Streed Jr. said in the release. Streed, who was not involved in the new study, is an assistant professor of internal medicine at Boston University School of Medicine and the research lead at GenderCare Center at Boston Medical Center.

"These disparity gaps pack a one-two punch to our transgender patients and communities for a number of reasons," said Streed, who led the writing of the 2021 scientific statement from the AHA about the cardiovascular health of transgender and gender-diverse people in the United States. "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."

That's why, he said, more research and programs are needed "to ensure equitable health and health care for all people, especially persons and communities most at risk due to various diversity gaps in care."

Find more news from Scientific Sessions.