Lake Jordan E, Feng Han, Hyatt Ana N, Miao Hongyu, Debroy Paula, Funderburg Nicholas, Ailstock Kate, Dobs Adrian, Haberlen Sabina, Magnani Jared W, Margolick Joseph B, McGowan Kate, Palella Frank J, Witt Mallory D, Bhasin Shalender, Budoff Matthew J, Post Wendy S, Brown Todd T
Department of Medicine, UTHealth Houston, Houston, TX 77030, USA.
Tulane Research and Innovation for Arrhythmia Discoveries-TRIAD Center, Tulane University School of Medicine, New Orleans, LA 70112, USA.
J Endocr Soc. 2024 Jun 27;8(8):bvae120. doi: 10.1210/jendso/bvae120. eCollection 2024 Jul 1.
Cardiovascular disease (CVD) in transgender women (TW) may be affected by gender-affirming hormone therapy (GAHT) and HIV, but few data compare TW on contemporary GAHT to well-matched controls.
We compared CVD burden and biomarker profiles between TW and matched cisgender men (CM).
Adult TW on GAHT (n = 29) were recruited for a cross-sectional study (2018-2020). CM (n = 48) from the former Multicenter AIDS Cohort Study were matched 2:1 to TW on HIV serostatus, age ±5 years, race/ethnicity, BMI category and antiretroviral therapy (ART) type. Cardiac parameters were measured by CT and coronary atherosclerosis by coronary CT angiography; sex hormone and biomarker concentrations were measured centrally from stored samples.
Overall, median age was 53 years and BMI 29 kg/m; 69% were non-white. All participants with HIV (71%) had viral suppression on ART. Only 31% of TW had testosterone suppression (<50 ng/dL, TW-S). Traditional CVD risk factors were similar between groups, except that TW-S had higher BMI than TW with non-suppressed testosterone (TW-T). TW-S had no evidence of non-calcified coronary plaque or advanced coronary stenosis, whereas TW-T and CM had similar burden. TW had lower prevalence of any coronary plaque, calcified plaque and mixed plaque than CM, regardless of testosterone concentrations and HIV serostatus. Estradiol but not testosterone concentrations moderately and negatively correlated with the presence of coronary plaque and stenosis. Small sample size limited statistical power.
Older TW with suppressed total testosterone on GAHT had no CT evidence of non-calcified coronary plaque or advanced coronary stenosis. Longitudinal studies to understand relationships between GAHT and CVD risk in TW are needed.
跨性别女性（TW）的心血管疾病（CVD）可能受性别确认激素疗法（GAHT）和艾滋病毒影响，但很少有数据将接受当代GAHT的TW与匹配良好的对照组进行比较。
我们比较了TW与匹配的顺性别男性（CM）之间的CVD负担和生物标志物谱。
招募接受GAHT的成年TW（n = 29）进行横断面研究（2018 - 2020年）。来自前多中心艾滋病队列研究的CM（n = 48）按2:1与TW在艾滋病毒血清学状态、年龄±5岁、种族/族裔、BMI类别和抗逆转录病毒疗法（ART）类型方面进行匹配。通过CT测量心脏参数，通过冠状动脉CT血管造影测量冠状动脉粥样硬化；从储存样本中集中测量性激素和生物标志物浓度。
总体而言，中位年龄为53岁，BMI为29 kg/m²；69%为非白人。所有感染艾滋病毒的参与者（71%）在接受ART治疗后病毒得到抑制。只有31%的TW睾酮受到抑制（<50 ng/dL，TW - S）。两组之间传统的CVD危险因素相似，只是TW - S的BMI高于睾酮未受抑制的TW（TW - T）。TW - S没有非钙化冠状动脉斑块或重度冠状动脉狭窄的证据，而TW - T和CM的负担相似。无论睾酮浓度和艾滋病毒血清学状态如何，TW的任何冠状动脉斑块、钙化斑块和混合斑块的患病率均低于CM。雌二醇而非睾酮浓度与冠状动脉斑块和狭窄的存在呈中度负相关。样本量小限制了统计效力。
接受GAHT且总睾酮受到抑制的老年TW没有CT证据显示存在非钙化冠状动脉斑块或重度冠状动脉狭窄。需要进行纵向研究以了解GAHT与TW的CVD风险之间的关系。
