Background:
Risk of cardiovascular disease (CVD) may be higher in sexual minorities, but epidemiologic evidence is sparse. We used a nationally representative sample of young adults to examine sex-specific disparities in global CVD risk by sexual orientation and race/ethnicity.
Methods:
Data were from National Longitudinal Study of Adolescent Health subjects who participated in wave 4 (2008-09) and who had valid weights and non-missing data (7087 women; 6340 men). Age, race/ethnicity, sexual orientation, education, financial stress, and CVD risk factors (body mass index, smoking, diabetes, systolic blood pressure, and use of antihypertensive medication) were collected via an in-home interview. We calculated the 30-Year risk for total CVD using a Framingham-based prediction model. Sex-specific differences in 30-year risk of CVD by sexual orientation were calculated with weighted linear models adjusted for age, race/ethnicity, education, and financial distress. Sex-specific interactions between race/ethnicity and sexual orientation were tested.
Results:
Mean age was 28.9 ± .2 years; 93% (n=5912) of male participants were heterosexual, 4% (n=258) were bisexual, and 2% (n=170) were gay. 80% (n=5713) of female participants were heterosexual, 18% (n=1243) were bisexual, and 2% (n=131) were lesbian. Average 30-year risk of CVD was 17.2 ± .5% in men and 9.0 ± .3% in women. Differences in CVD risk by sexual orientation were not detectable for men (p=.59). Compared to heterosexual women, bisexual and lesbian women had a .9% (95% CI: .3, 1.4) and 2.0% (95% CI: .7, 3.2) higher risk of CVD, respectively. In race/ethnicity stratified models (interaction p-value=.01), an increased risk among sexual minorities, especially lesbians, was detectable except among Hispanic women (Figure).
Conclusion:
Disparities in global CVD risk were observed by sexual orientation for women and persisted across most racial/ethnic groups. Sexual orientation may be a marker of increased risk of CVD but more research on contributing factors is needed.
Longitudinal trajectories of BMI and cardiovascular disease risk: The national longitudinal study of adolescent health
