scholarly journals Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse: A Scientific Statement From the American Heart Association

Circulation ◽  
2021 ◽  
Author(s):  
Carl G. Streed ◽  
Lauren B. Beach ◽  
Billy A. Caceres ◽  
Nadia L. Dowshen ◽  
Kerrie L. Moreau ◽  
...  

There is growing evidence that people who are transgender and gender diverse (TGD) are impacted by disparities across a variety of cardiovascular risk factors compared with their peers who are cisgender. Prior literature has characterized disparities in cardiovascular morbidity and mortality as a result of a higher prevalence of health risk behaviors. Mounting research has revealed that cardiovascular risk factors at the individual level likely do not fully account for increased risk in cardiovascular health disparities among people who are TGD. Excess cardiovascular morbidity and mortality is hypothesized to be driven in part by psychosocial stressors across the lifespan at multiple levels, including structural violence (eg, discrimination, affordable housing, access to health care). This American Heart Association scientific statement reviews the existing literature on the cardiovascular health of people who are TGD. When applicable, the effects of gender-affirming hormone use on individual cardiovascular risk factors are also reviewed. Informed by a conceptual model building on minority stress theory, this statement identifies research gaps and provides suggestions for improving cardiovascular research and clinical care for people who are TGD, including the role of resilience-promoting factors. Advancing the cardiovascular health of people who are TGD requires a multifaceted approach that integrates best practices into research, health promotion, and cardiovascular care for this understudied population.

Circulation ◽  
2022 ◽  
Author(s):  
Joshua J. Joseph ◽  
Prakash Deedwania ◽  
Tushar Acharya ◽  
David Aguilar ◽  
Deepak L. Bhatt ◽  
...  

Cardiovascular disease remains the leading cause of death in patients with diabetes. Cardiovascular disease in diabetes is multifactorial, and control of the cardiovascular risk factors leads to substantial reductions in cardiovascular events. The 2015 American Heart Association and American Diabetes Association scientific statement, “Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence,” highlighted the importance of modifying various risk factors responsible for cardiovascular disease in diabetes. At the time, there was limited evidence to suggest that glucose-lowering medications reduce the risk of cardiovascular events. At present, several large randomized controlled trials with newer antihyperglycemic agents have been completed, demonstrating cardiovascular safety and reduction in cardiovascular outcomes, including cardiovascular death, myocardial infarction, stroke, and heart failure. This AHA scientific statement update focuses on (1) the evidence and clinical utility of newer antihyperglycemic agents in improving glycemic control and reducing cardiovascular events in diabetes; (2) the impact of blood pressure control on cardiovascular events in diabetes; and (3) the role of newer lipid-lowering therapies in comprehensive cardiovascular risk management in adults with diabetes. This scientific statement addresses the continued importance of lifestyle interventions, pharmacological therapy, and surgical interventions to curb the epidemic of obesity and metabolic syndrome, important precursors of prediabetes, diabetes, and comorbid cardiovascular disease. Last, this scientific statement explores the critical importance of the social determinants of health and health equity in the continuum of care in diabetes and cardiovascular disease.


Circulation ◽  
2020 ◽  
Vol 142 (19) ◽  
Author(s):  
Billy A. Caceres ◽  
Carl G. Streed ◽  
Heather L. Corliss ◽  
Donald M. Lloyd-Jones ◽  
Phoenix A. Matthews ◽  
...  

There is mounting evidence that lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) adults experience disparities across several cardiovascular risk factors compared with their cisgender heterosexual peers. These disparities are posited to be driven primarily by exposure to psychosocial stressors across the life span. This American Heart Association scientific statement reviews the extant literature on the cardiovascular health of LGBTQ adults. Informed by the minority stress and social ecological models, the objectives of this statement were (1) to present a conceptual model to elucidate potential mechanisms underlying cardiovascular health disparities in LGBTQ adults, (2) to identify research gaps, and (3) to provide suggestions for improving cardiovascular research and care of LGBTQ people. Despite the identified methodological limitations, there is evidence that LGBTQ adults (particularly lesbian, bisexual, and transgender women) experience disparities across several cardiovascular health metrics. These disparities vary by race, sex, sexual orientation, and gender identity. Future research in this area should incorporate longitudinal designs, elucidate physiological mechanisms, assess social and clinical determinants of cardiovascular health, and identify potential targets for behavioral interventions. There is a need to develop and test interventions that address multilevel stressors that affect the cardiovascular health of LGBTQ adults. Content on LGBTQ health should be integrated into health professions curricula and continuing education for practicing clinicians. Advancing the cardiovascular health of LGBTQ adults requires a multifaceted approach that includes stakeholders from multiple sectors to integrate best practices into health promotion and cardiovascular care of this population.


Author(s):  
В.В. Шерстнёв ◽  
М.А. Грудень ◽  
О.В. Сенько ◽  
В.П. Карлина ◽  
А.В. Кузнецова ◽  
...  

В настоящее время доказано, что предгипертензия, характеризующая состояние лиц с артериальным давлением (АД) от 120/80 мм рт.ст. до 139/89 мм рт.ст., имеет высокую и постоянно возрастающую распространенность среди населения во всем мире и является независимым фактором риска формирования артериальной гипертонии, развития сердечно-сосудистой заболеваемости и смертности. Это делает актуальным изучение взаимосвязи развития предгипертензии с наличием других факторов риска сердечно-сосудистых заболеваний. Целью данного исследования явилось изучение гендерных особенностей взаимосвязи факторов риска сердечно-сосудистых заболеваний и развития предгипертензии. Методы исследования. Проведен сравнительный и корреляционный анализ показателей модифицируемых и немодифицируемых факторов риска сердечно-сосудистых заболеваний у 115 обследованных лиц мужского (n = 49) и женского пола (n = 66), средний возраст которых составил 47,6 ± 0,7 года с оптимальным АД (n = 63, АД < 120/80 мм рт.ст.) и предгипертензией (n = 52, АД 120-139/80-89 мм рт.ст.). Результаты исследования. Обнаружено, что мужчины и женщины с оптимальным АД и с предгипертензией различаются спектром факторов риска и структурой взаимосвязи исследованных показателей. У мужчин предгипертензия ассоциирована с повышенным содержанием креатинина в крови и табакокурением, тогда как у женщин - с гипертрофией левого желудочка сердца, стрессом и наследственной отягощенностью по гипертонической болезни. Развитие предгипертензии у женщин по сравнению с мужчинами характеризуется более выраженными количественными и качественными изменениями структуры взаимосвязей показателей исследованных факторов риска сердечно-сосудистых заболеваний. Заключение. Полученные результаты представляют интерес для понимания механизмов патогенеза предгипертензии и разработки стратегии её персонифицированной немедикаментозной и медикаментозной профилактики, основанной на устранении или ослаблении определенных факторов риска сердечно-сосудистых заболеваний. Currently it is proved that prehypertension characterizing the condition of individuals with blood pressure (BP) from 120/80 mm Hg to 139/89 mm Hg has a high, continuously increasing prevalence worldwide and is an independent risk factor for development of arterial hypertension and cardiovascular morbidity and mortality, which justifies studying the relationship between prehypertension and the presence of other risk factors for cardiovascular diseases. The aim of this study was to investigate gender features of the relationship between risk factors for cardiovascular disease and development of prehypertension. Methods. Comparative and correlation analyses of modifiable and non-modifiable cardiovascular risk factors were performed for 115 males (n = 49) and females (n = 66) aged 47.6 ± 0.7 with optimal BP (n = 63, BP < 120/80 mm Hg) or prehypertension (n = 52, AD = 120-139/80-89 mm Hg). Results. Men and women with optimal BP and prehypertension differed in the array of risk factors and the structure of relationship between the studied indices. In men, prehypertension was associated with an elevated blood creatinine and tobacco smoking whereas in women - with left ventricular hypertrophy, stress, and hereditary burden of hypertension. The development of prehypertension in women compared to men was characterized by more pronounced quantitative and qualitative changes in the structure of interrelationships between indices of the studied cardiovascular risk factors. Conclusion. The obtained results provide insight into pathogenetic mechanisms of prehypertension. They can be used for developing a strategy for individualized non-drug and drug prevention of hypertension based on elimination or reduction of certain cardiovascular risk factors.


Author(s):  
E. B. Shapovalova ◽  
S. A. Maksimov ◽  
G. V. Artamonova

Despite the many unresolved issues on gender characteristics of cardiovascular health, accumulated data allows to generalize global, national, ethnic, and social patterns. There are small deal of domestic studies that not always presented at a high evidentiary level. Meanwhile, in foreign literature, the study of gender characteristics is given an important place. The purpose of this review is to highlight the gender characteristics of the prevalence of the main cardiovascular risk factors according to literature data. The article shows the gender trends in the prevalence of the main determinants of cardiovascular health. It can be assumed that the cardiovascular continuum has a gender orientation and is triggered by men and women with “its own” cardiovascular risk factors. The development of this direction will help to form a gender-based prevention and treatment strategy to predict and limit adverse outcomes in a particular region of the country.


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