丹麦跨性别者的心血管风险：一项匹配的历史队列研究。

Cardiovascular risk in Danish transgender persons: a matched historical cohort study.

机构信息

Department of Endocrinology, Odense University Hospital, Odense, Denmark.

Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.

出版信息

Eur J Endocrinol. 2022 Aug 5;187(3):463-477. doi: 10.1530/EJE-22-0306. Print 2022 Sep 1.

DOI:10.1530/EJE-22-0306

PMID:35900321

Abstract

BACKGROUND

Cardiovascular risk could be increased in transgender persons, but the mechanism is undetermined.

AIM

The aim of this study was to assess the risk of cardiovascular outcomes in Danish transgender persons compared to controls.

METHODS

The study design was a historical register-based cohort study in Danish transgenders and age-matched controls. The main outcome measure was cardiovascular diagnosis (any CVD) including medicine prescriptions for CVD during 2000-2018. The transgender cohort (n = 2671) included persons with International Classification of Diseases-10 diagnosis code of 'gender identity disorder' (n = 1583) and persons with legal sex change (n = 1088), 1270 were assigned female at birth (AFAB) and 1401 were assigned male at birth (AMAB). Controls (n = 26 710) were matched by age (n = 5 controls of same and n = 5 controls of other birth sex) of the respective transgender.

RESULTS

The median (interquartile range) age at study inclusion was 22 (18; 29) years for AFAB and 26 (21; 39) years for AMAB. The mean (s.d.) follow-up time was 4.5 (4.2) years for AFAB and 5.7 (4.8) years for AMAB. The hazard ratio (HR) for any CVD was significantly higher in transgenders vs controls of same and other birth sex, with highest adjusted HR in transgenders AFAB vs control men: 2.20 (95% CI: 1.64;2.95), P < 0.001. Gender-affirming hormone treatment (GAHT) explained part of elevated risk of CVD in transgenders AFAB, whereas GAHT did not contribute to the elevated risk of CVD in transgenders AMAB.

CONCLUSIONS

The risk of cardiovascular diagnosis was increased in transgenders. The mechanism should be further investigated.

摘要

背景

心血管风险可能在跨性别者中增加，但机制尚未确定。

目的

本研究旨在评估丹麦跨性别者与对照组相比发生心血管结局的风险。

方法

研究设计为丹麦跨性别者和年龄匹配对照者的历史性基于登记的队列研究。主要结局测量指标是心血管诊断（任何 CVD），包括 2000-2018 年期间 CVD 的药物处方。 transgender 队列（n = 2671）包括国际疾病分类-10 诊断代码为“性别认同障碍”的人（n = 1583）和合法性别改变的人（n = 1088），1270 人被指定为女性（AFAB），1401 人被指定为男性（AMAB）。对照组（n = 26710）按相应 transgender 的年龄（n = 5 名同性别和 n = 5 名其他出生性别的对照）进行匹配。

结果

AFAB 的研究纳入时年龄中位数（四分位间距）为 22（18；29）岁，AMAB 为 26（21；39）岁。AFAB 的平均（标准差）随访时间为 4.5（4.2）年，AMAB 为 5.7（4.8）年。与同性别和其他出生性别的对照组相比，跨性别者发生任何 CVD 的风险比（HR）显著更高，AFAB 跨性别者与男性对照组相比，调整后的 HR 最高：2.20（95%CI：1.64；2.95），P<0.001。跨性别者 AFAB 中，性别肯定激素治疗（GAHT）部分解释了 CVD 风险增加，但 GAHT 并未导致跨性别者 AMAB 的 CVD 风险增加。