Alzahrani Talal, Nguyen Tran, Ryan Angela, Dwairy Ahmad, McCaffrey James, Yunus Raza, Forgione Joseph, Krepp Joseph, Nagy Christian, Mazhari Ramesh, Reiner Jonathan
Division of Cardiology, Department of Medicine, George Washington University, Washington, DC.
Circ Cardiovasc Qual Outcomes. 2019 Apr;12(4):e005597. doi: 10.1161/CIRCOUTCOMES.119.005597.
As of 2016, ≈1.4 million people in the United States identify as transgender. Despite their growing number and increasing specific medical needs, there has been a lack of research on cardiovascular disease (CVD) and CVD risk factors in this population. Recent studies have reported that the transgender population had a significantly higher rate of CVD risk factors without a significant increase in overall CVD morbidity and mortality. These studies are limited by their small sample sizes and their predominant focus on younger transgender populations. With a larger sample size and inclusion of broader age range, our study aims to provide insight into the association between being transgender and cardiovascular risk factors, as well as myocardial infarction.
The Behavioral Risk Factor Surveillance System data from 2014 to 2017 were used to evaluate the cross-sectional association between being transgender and the reported history of myocardial infarction and CVD risk factors. A logistic regression model was constructed to study the association between being transgender and myocardial infarction after adjusting for CVD risk factors including age, diabetes mellitus, hypertension, hypercholesterolemia, chronic kidney disease, smoking, and exercise. Multivariable analysis revealed that transgender men had a >2-fold and 4-fold increase in the rate of myocardial infarction compared with cisgender men (odds ratio, 2.53; 95% CI, 1.14-5.63; P=0.02) and cisgender women (odds ratio, 4.90; 95% CI, 2.21-10.90; P<0.01), respectively. Conversely, transgender women had >2-fold increase in the rate of myocardial infarction compared with cisgender women (odds ratio, 2.56; 95% CI, 1.78-3.68; P<0.01) but did not have a significant increase in the rate of myocardial infarction compared with cisgender men.
The transgender population had a higher reported history of myocardial infarction in comparison to the cisgender population, except for transgender women compared with cisgender men, even after adjusting for cardiovascular risk factors.
截至2016年，美国约有140万人认定自己为跨性别者。尽管这一群体数量不断增加且特定医疗需求日益增长，但针对该人群的心血管疾病（CVD）及CVD危险因素的研究却很匮乏。近期研究报告称，跨性别者的CVD危险因素发生率显著更高，而总体CVD发病率和死亡率并未显著增加。这些研究存在样本量小以及主要关注年轻跨性别群体的局限性。本研究样本量更大且纳入了更广泛的年龄范围，旨在深入了解跨性别身份与心血管危险因素以及心肌梗死之间的关联。
使用2014年至2017年行为危险因素监测系统的数据来评估跨性别身份与报告的心肌梗死病史及CVD危险因素之间的横断面关联。构建了一个逻辑回归模型，在调整包括年龄、糖尿病、高血压、高胆固醇血症、慢性肾脏病、吸烟和运动等CVD危险因素后，研究跨性别身份与心肌梗死之间的关联。多变量分析显示，与顺性别男性相比，跨性别男性的心肌梗死发生率增加了2倍以上和4倍（比值比，2.53；95%可信区间，1.14 - 5.63；P = 0.02），与顺性别女性相比增加了4倍（比值比，4.90；95%可信区间，2.21 - 10.90；P < 0.01）。相反，与顺性别女性相比，跨性别女性的心肌梗死发生率增加了2倍以上（比值比，2.56；95%可信区间，1.78 - 3.68；P < 0.01），但与顺性别男性相比，心肌梗死发生率没有显著增加。
即使在调整心血管危险因素后，与顺性别群体相比，跨性别群体报告的心肌梗死病史更高，但跨性别女性与顺性别男性相比除外。
