News | Cardiac Diagnostics | February 18, 2019

Hormone Therapy May Increase Cardiovascular Risk During Gender Transition

Findings underscore the importance of counseling and close monitoring of transgender patients receiving hormone therapy

Hormone Therapy May Increase Cardiovascular Risk During Gender Transition

February 18, 2019 — Patients receiving hormone therapy as part of their gender-transition treatment had an elevated risk for cardiovascular events, including strokes, heart attacks and blood clots, according to a study published in the American Heart Association’s journal Circulation.1

The results are based on analysis of medical records of 3,875 Dutch individuals who received hormone treatment between 1972 and 2015 as part of their gender transition.

“In light of our results, we urge both physicians and transgender individuals to be aware of this increased cardiovascular risk,” said study author Nienke Nota, M.D., a researcher in the department of endocrinology at the Amsterdam University Medical Center. “It may be helpful to reduce risk factors by stopping smoking, exercising, eating a healthy diet and losing weight, if needed before starting therapy, and clinicians should continue to evaluate patients on an ongoing basis thereafter.”

Past research has shown that hormone therapy increases cardiovascular risk among people receiving it to alleviate symptoms of menopause, yet research evidence remains scarce on the effects of hormone treatment in people undergoing gender transition. Even though such individuals tend to be younger than menopausal patients receiving hormone-replacement therapy, transgender people may have more psychosocial stressors and other factors that increase cardiovascular risk, the researchers said.

The analysis involved 2,517 transgender women, median age 30, who received estrogen, with or without androgen-suppressors, and 1,358 transgender men, median age 23, who received testosterone as part of their transition.

To gauge risk, the researchers determined the incidence of acute cardiovascular events — heart attacks, strokes and deep vein thromboses . They compared the incidence of such cases in the transgender population to that reported in the general population. Transwomen were followed for an average of 9 years since start of hormone therapy, while transmen were followed for an average of 8 years after starting with hormones.

The analysis showed that transwomen — individuals assigned male sex at birth but with female gender identity who were receiving hormones as part of their transition — had more than twice as many strokes as women (29 versus 12) and nearly twice as many strokes as men (29 versus 16). There were five times as many deep-vein clots among transwomen (73) than women (13) and 4.5 times more than men (73 versus 16). Heart attacks occurred at more than twice the rate among transwomen (30) than women (13). Transmen — those assigned female sex at birth but who had male gender identity and received hormones — had a more than three-fold elevation in heart-attack risk compared with women (11 versus 3).

The study was not designed to tease out the mechanism behind the increased risk. The researchers caution that their study was based solely on a review of medical records and could not account for risk factors such as smoking, psychosocial stressors, dietary and exercise habits. While those risk factors probably contribute to the increased cardiovascular risk, the researchers suggest that the hormone therapy may contribute to increased risk as well.

In previous studies it has been shown that triglyceride and insulin levels, for example, have both increased as a result of estrogen therapy and both are known to promote clogging and inflammation of the blood vessels. Additionally, estrogen therapy can render the blood more prone to clotting, which may explain the higher rate of strokes and blood clots observed in transwomen, the authors said. The rise in heart attack risk observed in transmen receiving testosterone may be explained partly by the hormone’s tendency to make the blood stickier by increasing the concentration of red blood cells along with lowering the level of good cholesterol and raising the level of bad cholesterol, the research team said.

Martin den Heijer, M.D., Ph.D., professor of internal medicine at Vrije University, was senior author on the research.  Other co-investigators included Chantal Wiepjes, M.D.; Christel de Blok, M.D.; Louis Gooren, M.D., Ph.D.; and Baudewijntje Kreukels, M.D., Ph.D.; all of Amsterdam University Medical Center.

There were no funding sources and no disclosures for any of the researchers.

For more information: www.ahajournals.org/journal/circ

Reference

1. Nota N.M., Wiepjes C.M., de Blok C.J.M., et al. The Occurrence of Acute Cardiovascular Events in Transgender Individuals Receiving Hormone Therapy: Results from a Large Cohort Study. Circulation, Feb. 18, 2019. https://doi.org/10.1161/CIRCULATIONAHA.118.038584

Related Content

World Heart Federation Launches Global Roadmap on Cardiovascular Disease Prevention Among Diabetics
News | Cardiac Diagnostics | September 04, 2019
At the European Society of Cardiology (ESC) Congress 2019 together with the World Congress of Cardiology, the World...
Insomnia Tied to Higher Risk of Heart Disease and Stroke

Image courtesy of the American Heart Association

News | Cardiac Diagnostics | August 19, 2019
People suffering from insomnia may have an increased risk of coronary artery disease, heart failure and stroke,...
Evolutionary Gene Loss May Help Explain Human Predisposition to Heart Attacks
News | Cardiac Diagnostics | July 29, 2019
The loss of a single gene two to three million years ago in our ancestors may have resulted in a heightened risk of...
U.S. Soldiers Have Worse Heart Health Than Civilians
News | Cardiac Diagnostics | June 06, 2019
Active duty Army personnel have worse cardiovascular health compared to people of similar ages in the civilian...
Late Dinner and No Breakfast Worsens Outcomes After Heart Attack
News | Cardiac Diagnostics | May 23, 2019
People who skip breakfast and eat dinner near bedtime have worse outcomes after a heart attack, according to research...
HRS Releases New Expert Consensus Statement on Arrhythmogenic Cardiomyopathy
News | Cardiac Diagnostics | May 14, 2019
The Heart Rhythm Society (HRS) released a first-of-its-kind consensus statement with guidance on the evaluation and...
New Best Practices Help Manage Heart Attack Patients Without Significant Signs
News | Cardiac Diagnostics | April 15, 2019
For the first time in the United States, doctors with the American Heart Association (AHA) have outlined best practices...
The most recent U.S. Food and Drug Administration (FDA) clearance was Siemens Healthineers high-sensitivity troponin I assays (TnIH) for the Atellica IM and ADVIA Centaur XP/XPT in vitro diagnostic analyzers. The test helps in the early diagnosis of myocardial infarctions without the need for serial tropic testing. The time to first results is 10 minutes.

The most recent U.S. Food and Drug Administration (FDA) clearance was Siemens Healthineers high-sensitivity troponin I assays (TnIH) for the Atellica IM and ADVIA Centaur XP/XPT in vitro diagnostic analyzers. The test helps in the early diagnosis of myocardial infarctions without the need for serial tropic testing. The time to first results is 10 minutes. 

Feature | Cardiac Diagnostics | March 22, 2019 | Linda C. Rogers, Ph.D.
Troponins are a family of proteins found in skeletal and heart (cardiac) muscle fibers that produce muscular contract
ACC/AHA Update Guidance for Preventing Heart Disease; Stroke
Feature | Cardiac Diagnostics | March 18, 2019
The choices we make every day can have a lasting effect on our heart and vascular health. Adopting a heart healthy...
Overlay Init