The statement is a reminder that heart disease, the leading cause of death in the United States, can affect anyone regardless of sexual orientation or gender identity. A study published in April 2019 in Circulation: Cardiovascular Quality and Outcomes analyzed health survey data from a four-year period to compare the rates of cardiovascular disease and heart attack in transgender men and women with those of cisgender men and women. Researchers found that on average, transgender people have a higher risk of heart attack than their cisgender counterparts. “I think that it’s increasingly been recognized that this disparity exists,” says Abha Khandelwal, MD, a clinical associate professor of cardiovascular medicine at Stanford Medicine in California.
Treating and Preventing Heart Disease Early Is Critical
Philip Chan, MD, an associate professor in the department of medicine at Brown University in Providence, Rhode Island, says that fear of discrimination and stigma is a major factor in the LGBTQ+ community. “Preventative health is crucial for cardiovascular health,” says Dr. Chan, who is also the chief medical officer at Open Door Health, Rhode Island’s first clinic dedicated to providing primary and sexual healthcare to LGBTQ+ patients. “A lot of people in the LGBTQ+ community have had negative experiences with the healthcare system.” This discourages people from seeking healthcare for any reason, including basic primary care, he says, explaining that as a result, “sometimes these folks present with much more severe disease and complications because it hasn’t been addressed earlier.” Despite growing acceptance of LGBTQ+ individuals in society, 1 in 8 LGBTQ+ adults report experiencing discrimination from health insurance, and many LGBTQ+ people hesitate going to the doctor because of discrimination. LGBTQ+ people also use tobacco products at higher rates than heterosexual people; 1 in 6 lesbian, gay, and bisexual adults smoke compared with 1 in 8 heterosexual people, according to the American Lung Association (ALA). Another ALA report (PDF) details that stigma and stressors such as homophobia and discrimination are factors that lead to more smoking, which is a major risk factor for heart disease.
More LGBTQ+ Research Is Needed
Research so far has looked at how stressors affect cardiovascular health, but data focused on the LGBTQ+ community remains limited. In the past decade, studies have looked at how mental health plays a role in physical health and how stress can contribute to increased inflammation, which impacts heart health. A review published in the American Journal of Hypertension found that depression, traumatic stress, anxiety, and exposure to daily stressors all have negative impacts on heart health. It is well established that LGBTQ+ people have higher rates of mental health disorders, such as anxiety and depression, as reported by the census. Dr. Khandelwal says that her LGBTQ+ patients often ask her if taking hormones can affect their heart health, but the research isn’t there yet. “We don’t have great population-based studies for me to guide them,” she says.
Health Providers and Clinics Need to Be Culturally Competent
Khandelwal says that the medical school training specific to caring for LGBTQ+ patients has been evolving but still doesn’t cut it. “As physicians, we are not well trained to take care of this community. It’s becoming increasingly apparent that we need to improve our medical education system to be better equipped to care for these patients,” she says. At Open Door Health, doctors put the patient first and listen to their perspective, Chan explains, but this isn’t necessarily the norm. “Clinics in general should strive to be patient centered and patient friendly,” he says. “We try not to be as prescriptive as directive and try to work with the patient to come to mutual goals to improve things like cardiovascular health.” The AHA statement recommends increasing training so doctors are better equipped to treat LGBTQ+ people in an appropriate and compassionate way. “Incorporating LGBTQ+ content into the curricula of health professions schools and postgraduate training, and requiring continuing education on LGBTQ+ health for all practicing clinicians that includes content on cardiovascular health disparities, would go a long way to address disparities,” says Donald Lloyd-Jones, MD, a former president of the AHA who is currently the department chair of preventive medicine at the Feinberg School of Medicine at Northwestern University in Chicago. Chan says that using a patient’s correct pronouns is one key way to create a positive patient-doctor dynamic. According to the book Cultural Competence in the Care of LGBTQ Patients, healthcare institutions can do a lot more to be more welcoming to the LGBTQ+ community. Providers and healthcare workers should familiarize themselves with LGBTQ+ terminology; hire LGBTQ+ staff; include brochures, posters, and magazines that are LGBTQ+ specific to health conditions; and audit forms to make sure that patients can correctly mark their gender, sexuality, and relationship status.
