Prevalence and Predictors of Cardiovascular Disease and Risk Factors in Transgender Persons in the United States.

BACKGROUND The cardiovascular health of transgender and gender diverse (TGD) persons, a growing population in the U.S., has become a subject of heightened interest. We sought to assess the prevalence and predictors of cardiovascular disease (CVD) in transgender men, transgender women, and gender non-conforming persons in the U.S. METHODS A cohort of individuals self-identified as TGD (i.e. transgender or gender non-conforming) in the U.S. was identified using the 2018 Centers for Disease Control's Behavioral Risk Factor Surveillance Survey (BRFSS). RESULTS Among the 1,019 TGD individuals studied, 378 (37.1%) identified their transition status as male-to-female, 394 (38.7%) as female-to-male, and the remaining 247 (24.2%) as gender non-conforming. A total of 138 (13.5%) had reported CVD while 881 (86.5%) did not. The prevalence of CVD in TGD individuals identified as male-to-female, female-to-male, and gender non-conforming were noted to be similar (14.6% vs 13.5% vs 12.1%, p=0.69). TGD persons with CVD were older with lower annual income. They also had higher rates of smoking, lower rates of regular exercise, and higher rates of smoking and chronic medical comorbidities. Independent predictors of CVD in TGD persons included older age, diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, and depressive disorder. CONCLUSIONS In this contemporary cross-sectional nationally representative survey, CVD was prevalent in nearly 14% of TGD persons. Further studies examining interventions to reduce CV risk and enhance access to medical care in the TGD population are warranted.