Characteristics of Transgender Women Referred to Women's Heart Clinic

Madeline K Mahowald; Arvind K Maheshwari; Kyla M Lara-Breitinger; Fadi W Adel; Patricia A Pellikka; Caroline J Davidge-Pitts; Todd B Nippoldt; Birgit Kantor; Rekha Mankad

doi:10.1016/j.ajpc.2021.100223

Characteristics of Transgender Women Referred to Women's Heart Clinic

Am J Prev Cardiol. 2021 Jul 10:7:100223. doi: 10.1016/j.ajpc.2021.100223. eCollection 2021 Sep.

Authors

Madeline K Mahowald¹, Arvind K Maheshwari², Kyla M Lara-Breitinger¹, Fadi W Adel³, Patricia A Pellikka¹, Caroline J Davidge-Pitts², Todd B Nippoldt², Birgit Kantor¹, Rekha Mankad¹

Affiliations

¹ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
² Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
³ Department of Internal Medicine, Mayo Clinic, Rochester, MN.

Abstract

Introduction: Transgender women have been reported to have a high burden of cardiovascular disease (CVD) and risk factors based largely on surveys. Our aim was to describe the prevalence of CVD and associated comorbidities among a cohort of older transgender women referred to cardiology as part of their gender-affirming care.

Methods: This was a retrospective, cross-sectional study of transgender women at a single institution from 2017 to 2019.

Results: Fifty-two consecutive patients were included. The most common reasons for referral were cardiac risk factor management (45%) and pre-operative cardiac risk stratification prior to gender-affirming surgery (35%). The mean age was 57 ± 10 years, 87% were white, and 92% had insurance coverage. Forty-eight patients (92%) were taking gender-affirming hormone therapy; 5 had undergone breast augmentation, 4 had undergone orchiectomy, and 2 had undergone vaginoplasty. The most common comorbidities were depression and/or anxiety (63%), obesity (58%), and hyperlipidemia (54%). Excluding aldosterone antagonists, 46% were on cardiac medications; changes were recommended for 25% of patients: new prescriptions in 9, dose adjustments in 5, and discontinuations in 4. According to the pooled cohort equation, the 10-year risk of atherosclerotic CVD was 9.4 ± 7.7% when the study population was calculated as male and 5.2 ± 5.1% when calculated as female (p <0.001). For patients who completed exercise testing, the functional aerobic capacity was fair (77.6 ± 21.4%) when calculated as male and average (99.5 ± 27.5%) as female (p < .0001); there was inconsistency in sex used for calculating the result on the formal report.

Conclusions: Older transgender women may have an underestimated prevalence of CVD and its risk factors. More research is needed to identify cardiovascular health profiles, improve practice consistency, and establish normative values for transgender patients.

Keywords: Clinical cardiology; Endocrinology; Healthcare access; Women and minorities.