LGBTQIA+ adults are more vulnerable to heart disease; understand

While many attended Gay Pride in June, others in the medical community highlighted the devastating disparities in health outcomes for LGBTQIA+ adults – a disproportionate number of smallpox cases in men who have sex with men, high reported rates of alcohol abuse, barriers to access to cancer screenings and treatments.

But according to some health experts, one of the most critical health inequalities among LGBTQIA+ adults often goes unnoticed. A growing body of research shows that adults in the group are more likely to have worse heart health than their heterosexual peers.

Lesbian, gay and bisexual adults were 36% less likely than straight adults to have optimal cardiovascular health, the American Heart Association concluded in 2018, based on research into risk factors such as smoking and blood glucose levels.

In 2021, the organization released a statement on the high rates of heart disease among transgender and gender-diverse individuals, linking these high rates in part to the stress that comes from discrimination and transphobia.

The data confirms what LGBTQIA+ physicians and health researchers have observed for decades: that this community faces specific and far-reaching obstacles that affect the brain and body.

Cardiovascular disease is the leading cause of death in the United States. The CDC (Centers for Disease Control and Prevention) estimates that 80% of premature heart disease and stroke are preventable. But there are disparities where that burden falls among the general population.

We spoke with clinicians and health researchers about why these inequalities persist and what steps adults in the group can take to improve heart health.

The strain of stress

Experts said LGBTQIA+ adults face unique stressors — stigma, discrimination, fear of violence — that can directly and indirectly lead to illness.

Stress directly affects certain hormones that regulate blood pressure and heart rate, said Billy Caceres, an assistant professor in the School of Nursing and the Center for Research in Sexual and Gender Minority Health at Columbia University.

Hypervigilance — the feeling of always being on edge, constantly looking for the next threat — causes cortisol levels to spike, which can lead to long-term cardiovascular problems, said Carl Streed, an assistant professor at the University of California School of Medicine. Boston.

In addition, stress can cause chronic inflammation, said Erin Michos, associate director of preventive cardiology at the Johns Hopkins University School of Medicine, and can increase blood pressure and heart rate.

Researchers sometimes refer to allostatic load, the cumulative toll that chronic stress takes on the brain and body, said Scott Bertani, director of advocacy for HealthHIV, a nonprofit organization focused on advancing prevention and care for people at risk of HIV. HIV.

“It stands to reason that our bodies respond to these really complex and challenging life events and demands,” he said. For example, coming out as LGBTQIA+, and in some cases doing so repeatedly, often includes severe stress, he added.

To deal with the constant threat of discrimination or harassment, many in the LGBTQIA+ community self-medicate with drugs such as tobacco and alcohol, said Streed, who is also a researcher at Boston Medical Center’s Center for Transgender Medicine and Surgery. These industries target the community through advertising, he said, especially during Pride month.

The CDC reports that about 25% of lesbian, gay, or bisexual adults used a commercial tobacco product in 2020, compared with 18.8% of straight adults. The agency partially attributes the disparity to the tobacco industry’s long history of aggressive marketing campaigns.

Research has also identified a link between sleep and heart health, Caceres said. Growing evidence shows that LGBTQIA+ adults experience more sleep problems and disruptions than the general population, which may also be linked to chronic stress.

Obstacles to seeking care

A 2017 survey of nearly 500 LGBTQIA+ adults by researchers at Harvard’s TH Chan School of Public Health and the Robert Wood Johnson Foundation found that more than 1 in 6 reported avoiding health care because they were concerned about discrimination.

This hesitancy means that adults in the group are less likely to access life-saving preventive health care, Michos said. All adults should be screened at least once a year for cardiovascular risk factors, which is typically part of an annual physical exam, she said.

Finding medical providers that a person feels comfortable and safe with can be key to preventing heart disease, experts said. Streed recommends that LGBTQIA+ adults seek out supportive doctors.

What LGBTQIA+ Adults Should Do

While gender-affirming hormones have been shown to have a positive impact on mental health, Michos said, there is some evidence that high amounts of testosterone and estrogen may pose cardiovascular risks. People who are taking these hormones should consult their doctors about maintaining heart health.

The American Heart Association recommends seven steps to optimal heart health: controlling blood pressure, keeping cholesterol levels low, lowering blood sugar, exercising daily, eating a nutritious diet, maintaining a healthy body weight, and not smoking. .

Michos also recommended minimizing consumption of processed foods, sugary drinks, and highly refined carbohydrates, opting for whole grains, lean proteins, and lots of fruits and vegetables. Adults should also get at least 30 minutes of moderate-intensity exercise every day, such as brisk walking, running, or cycling.

These are critical facets of heart disease prevention, she added, “but we can’t just preach ‘You need to live a healthy lifestyle’ if individuals are under significant psychological distress and discrimination.”

Translated by Luiz Roberto M. Gonçalves