New observational research suggests that lesbian and bisexual women may be less likely to have ideal cardiovascular (CV) health scores than are heterosexual women and should be given priority for CV prevention strategies, researchers say.
Interestingly, they also found that gay or bisexual men may have better heart health than do heterosexual men but only if they lived in urban areas.
The study is the first to evaluate CV health disparities using the American Heart Association (AHA) Life’s Essential 8 (LE8) checklist among gay, lesbian, and bisexual individuals.
“Improving these metrics is a great opportunity to prevent heart problems before they happen,” lead author Omar Deraz, MD, with the French National Institute of Health and Medical Research (INSERM) and University of Paris, France, said in an AHA news release.
The study was published online May 17 in the Journal of the American Heart Association.
As previously reported by theheart.org | Medscape Cardiology, LE8 was updated in 2022 to add healthy sleep as a CV health factor in addition to the original seven metrics in Life’s Simple 7: healthy diet; regular physical activity; no smoking; healthy weight; and normal blood sugar, cholesterol, and blood pressure levels.
Prior research has shown that sexual-minority adults are less likely to access healthcare and more likely to delay healthcare than are heterosexual adults.
The new findings are based on 169,434 adults (mean age 46 years; 54% women) without CV disease (CVD) recruited from 2012 to 2020 to the CONSTANCES cohort, a French observational prospective cohort that examines multiple risk factors for chronic disease.
Among 90,879 women participating in the study, 93% identified as heterosexual, about 3.5% identified as bisexual, and less than 1% (0.61%) identified as lesbian.
Among the 78,555 men in the study, 90% identified as heterosexual; 3.5% identified as bisexual; and 3% identified as gay. About 3% of women and 3% of men declined to answer these questions.
After adjusting for multiple factors, including family history of CVD, age, and social factors, when CV health was scored using LE8 metrics, lesbian and bisexual women had significantly lower CV health scores compared with heterosexual women (0.95 and 0.78 points lower, respectively).
However, among women who were ever pregnant, lesbian women had higher CV health scores compared with heterosexual women.
CV health scores on the LE8 for gay and bisexual men were 2.72 and 0.83 points higher, respectively, compared with heterosexual men, with one caveat.
Gay and bisexual men living in rural areas had lower CV health scores compared with their urban-dwelling peers (mean LE8 score roughly 61 vs 66) and were less likely to attain ideal CV health compared with their heterosexual counterparts.
Deraz and colleagues say lesbian and bisexual women represent a “priority population for primordial” CVD prevention.
They note that sexual-minority groups report more frequent negative healthcare experiences than do their heterosexual peers. Recognizing and overcoming barriers to healthcare access is “essential” to improve CVD prevention and care provision in sexual-minority individuals, they write.
“Although this data may not be fully applicable to other countries, it’s important research into a population that is grossly underrepresented in clinical and epidemiological studies,” Connie W. Tsao, MD, MPH, who wasn’t involved in the study, said in the AHA news release.
“To fully address discrimination and disparities that impact health, we must better recognize and understand the unique experiences of all individuals and populations including sexual minorities,” said Tsao, with Harvard Medical School and Beth Israel Deaconess Medical Center, Boston.
The study was funded by the Caisse Nationale d’Assurance Maladie, the Ministry of Health, the Council of Île-de-France region and the Cohorts TGIR IReSP-ISP Inserm (Ministère de la Santé et des Sports, Ministère délégué à la Recherche, Institut National de la Santé et de la Recherche Médicale (Inserm), Institut National du Cancer (INCa) and Caisse Nationale de Solidarité pour l’Autonomie (CNSA). Deraz and Tsao have no relevant disclosures.
J Am Heart Assoc. Published online May 17, 2023. Full Text
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