In a study of nearly 170,000 adults in France, lesbian and bisexual women had lower cardiovascular health scores compared to heterosexual women.
In contrast, gay and bisexual men had higher ideal cardiovascular health scores compared to heterosexual men.
The study is the first to examine ideal cardiovascular health scores in sexual minorities.
New research published in the Journal of the American Heart Association highlights that lesbian and bisexual women have lower rates of ideal cardiovascular health compared to heterosexual women. This finding suggests that lesbian and bisexual women should be considered a priority group for cardiovascular disease prevention efforts. The study emphasizes the importance of addressing cardiovascular health disparities in these populations and underscores the need for tailored interventions to promote heart health among lesbian and bisexual women. The Journal of the American Heart Association is a reputable, open access, peer-reviewed journal associated with the American Heart Association.
In contrast to lesbian and bisexual women, gay and bisexual men were found to have higher rates of ideal cardiovascular health compared to heterosexual men. These findings come from a study conducted in France, which examined heart health disparities among sexual minority adults. The study utilized the American Heart Association's Life's Essential 8 and Life's Simple 7 metrics to assess ideal cardiovascular health. The results highlight the importance of understanding and addressing cardiovascular health disparities within different subgroups of the LGBTQ+ community.
This study is the first of its kind to investigate disparities in cardiovascular health among individuals who identify as part of a sexual minority group. The participants were categorized into groups based on self-reported lifetime sexual behavior, including lesbian, gay, bisexual, or heterosexual. Additionally, this study is likely the first to examine cardiovascular health in sexual minority groups using the American Heart Association's cardiovascular health metrics. The metrics used included the Life's Essential 8, which was updated in 2022 to include healthy sleep as an additional factor along with the original 7 metrics in Life's Simple 7. These metrics assess various aspects of cardiovascular health, such as healthy diet, regular physical activity, non-smoking, healthy weight, and normal levels of blood sugar, cholesterol, and blood pressure.
The lead study author, Omar Deraz, emphasized the importance of improving the cardiovascular health metrics as a means of preventing heart problems. The study aimed to examine whether there were disparities in the Life's Essential 8 cardiovascular health scores among sexual minority individuals, including gay, lesbian, and bisexual adults, in comparison to heterosexual individuals. Deraz is affiliated with Université Paris Cité, Inserm (French National Institute of Health and Medical Research), and the Paris Cardiovascular Research Center's Integrative Epidemiology of Cardiovascular Disease Team.
According to Omar Deraz, enhancing cultural competency and raising awareness about cardiovascular disease risk among sexual minority adults can facilitate better communication between healthcare providers and patients regarding cardiovascular health, prevention, and management. Recognizing and addressing barriers to accessing healthcare is crucial for improving cardiovascular disease prevention and care among sexual minority populations.
Enhancing cultural competency and raising awareness about cardiovascular disease risk among sexual minority adults can facilitate better communication between healthcare providers and patients regarding cardiovascular health, prevention, and management. Recognizing and addressing barriers to accessing healthcare is crucial for improving cardiovascular disease prevention and care among sexual minority populations.
The lead study author, Omar Deraz
Prior research has shown that sexual minority adults are less likely to access health care and more likely to delay health care than heterosexual adults, according to the study.
The research study analyzed health information from over 169,400 adults who were part of the CONSTANCES study conducted in France. These participants were selected randomly from 2012 to 2020 and did not have pre-existing cardiovascular disease. The average age of the participants was 46 years, and 54% of them were women. The CONSTANCES study focuses on examining risk factors for chronic diseases, including cardiovascular disease and the aging process. Participants underwent clinical examinations and laboratory tests at the beginning of the study and subsequently every four years.
Among the participants in the study, the majority identified as heterosexual, with approximately 93% of women and 90% of men identifying as such. Around 3.5% of women and men identified as bisexual, while a smaller percentage identified as gay (3% of men) or lesbian (0.61% of women). A small percentage of participants chose not to answer questions about their sexual behavior, accounting for approximately 3% of both women and men.
After adjusting for several factors including family history of cardiovascular disease, age and social factors, the analysis found:
When cardiovascular health was scored using Life’s Essential 8 metrics, lesbian and bisexual women had significantly lower cardiovascular health scores compared to heterosexual women, 0.95 and 0.78 points lower, respectively. However, among women who were ever pregnant, lesbian women had higher cardiovascular health compared to heterosexual women.
Cardiovascular health scores for gay and bisexual men were 2.72 and 0.83 points higher, respectively, compared to heterosexual men. Sexual minority men living in rural areas, however, had lower cardiovascular health scores (average Life’s Essential 8 score roughly 61) compared to their urban dwelling peers (average Life’s Essential 8 score about 66) and were less likely to attain ideal cardiovascular health compared to their heterosexual counterparts.
Compared to heterosexual women, lesbian women had lower scores for healthy diet and healthy blood pressure levels, as measured by Life’s Essential 8. In contrast, bisexual women had higher scores for healthy diet and also higher scores for nicotine exposure.
When measured using Life’s Simple 7 metrics, cardiovascular health scores were consistent with Life’s Essential 8 scores among all participant groups, though the differences were smaller.
The study authors note that while previous research has examined lifestyle risk factors for cardiovascular disease among sexual minorities, such as diet and physical activity, there has been limited focus on health factors like blood sugar, blood pressure, and cholesterol. Therefore, this study aimed to provide insights into these specific health factors and their relationship to cardiovascular health among individuals in sexual minority groups.
The study acknowledges that existing evidence suggests that sexual minority populations are more likely to experience mental health conditions, including depression and suicide attempts, which have been associated with a higher risk of cardiovascular disease. Furthermore, bias-motivated discrimination, violence, and additional societal stressors may contribute to unhealthy coping mechanisms, such as increased alcohol consumption, smoking, and a sedentary lifestyle. These factors may further contribute to the disparities in cardiovascular health observed among sexual minority individuals.
In this study, demographic and social determinants of health among lesbian, bisexual and gay participants were assessed in comparison to heterosexual participants:
On average, sexual minority adults were younger; less likely to be self-employed or work in a managerial position; had higher education levels described as at least two years of education beyond high school; less likely to live with a partner; more frequently lived in poverty or in urban areas; and more frequently had patterns of drinking excess alcohol compared to their heterosexual peers.
Sexual minority adults more frequently reported mental health conditions, such as anxiety disorders, depression symptoms, taking prescription medications for depression or a history of suicide attempts than heterosexual adults. However, lesbian women less frequently reported anxiety disorders and depression symptoms compared to heterosexual women.
Deraz suggests that the observed findings can be partially attributed to various living conditions, such as poverty, unfavorable working conditions, mental health issues, discrimination, and negative past experiences within the healthcare system. These factors may contribute to the disparities in cardiovascular health among sexual minority individuals. It highlights the importance of addressing these social determinants of health and creating inclusive and supportive environments to improve the cardiovascular well-being of sexual minority populations.
A 2020 American Heart Association scientific statement “Assessing and Addressing Cardiovascular Health in LGBTQ Adults,” noted that LGBTQ adults experience significant psychosocial stressors that compromise their cardiovascular health across the life span.
The researchers caution against generalizing the findings of the study to other countries, as the study was conducted in France, which has a high-income status and universal healthcare insurance. The specific healthcare and social contexts of other countries may influence the cardiovascular health outcomes of sexual minority individuals differently. Additionally, the study's focus was solely on assessing cardiovascular health based on sexual minority identification, and it did not include data on transgender individuals due to the unavailability of such data at the time. Therefore, further research is needed to examine the cardiovascular health of transgender populations and to explore the generalizability of the findings across different countries and healthcare systems.
Connie W. Tsao, volunteer chair of the American Heart Association's 2023 Statistical Update writing group, emphasizes the significance of the research in addressing the underrepresentation of sexual minority populations in clinical and epidemiological studies. While the data may have limitations in its applicability to other countries, it serves as an important contribution to the field and highlights the need for more inclusive research to better understand the cardiovascular health of sexual minority individuals. Tsao is an assistant professor of medicine at Harvard Medical School and an attending staff cardiologist at Beth Israel Deaconess Medical Center in Boston.
Connie W. Tsao emphasizes the importance of recognizing and understanding the unique experiences of all individuals and populations, including sexual minorities, in order to address discrimination and health disparities effectively. The writing group of the American Heart Association's Statistical Update made a deliberate effort to include research on social and demographic factors, such as sexual orientation and gender identity, to gain a better understanding of health risks and outcomes. Studies like the one discussed in this context contribute to filling the knowledge gap regarding cardiovascular health among sexual minority populations. This knowledge is crucial for the American Heart Association's mission to achieve cardiovascular health equity for everyone.
Deraz and his co-authors recommend that future research should expand its focus to include social demographics such as sexual orientation, sex, gender identity, and gender expression. They also emphasize the importance of further investigating the relationship between cardiovascular health scores and the risk of heart disease among sexual minority populations. By including these factors and conducting more comprehensive studies, we can gain a deeper understanding of the cardiovascular health of sexual minority individuals and develop targeted interventions and strategies to improve their overall heart health.