Cardiovascular Disease Risk Estimation for Transgender and Gender-Diverse Patients: Cross-Sectional Analysis of Baseline Data From the LITE Plus Cohort Study
Tonia C. Poteat, PhD, PA-C,
Ashleigh J. Rich, PhD,
Huijun Jiang, MS,
Andrea L. Wirtz, PhD,
Asa Radix, MD, PhD,
Sari L. Reisner, ScD,
Alexander B. Harris, MPH,
Christopher M. Cannon, MPH,
Catherine R. Lesko, PhD,
Mannat Malik, MHS,
Jennifer Williams, PhD,
Kenneth H. Mayer, MD,
Carl G. Streed, Jr, MD
Affiliations
Tonia C. Poteat, PhD, PA-C
Department of Social Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Address correspondence to: Tonia Poteat, PhD, PA-C, Department of Social Medicine, The University of North Carolina at Chapel Hill, 333 South Columbia Street, CB 7240, Chapel Hill NC 27599.
Ashleigh J. Rich, PhD
Department of Social Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Huijun Jiang, MS
Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Andrea L. Wirtz, PhD
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Asa Radix, MD, PhD
Callen-Lorde Community Health Center, New York, New York
Sari L. Reisner, ScD
Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; The Fenway Institute, Fenway Health, Boston, Massachusetts
Alexander B. Harris, MPH
Callen-Lorde Community Health Center, New York, New York
Christopher M. Cannon, MPH
Research Department, Whitman-Walker Institute, Washington, District of Columbia
Catherine R. Lesko, PhD
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Mannat Malik, MHS
Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Jennifer Williams, PhD
Department of Social Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Kenneth H. Mayer, MD
Department of Medicine, Harvard Medical School, Boston, Massachusetts; The Fenway Institute, Fenway Health, Boston, Massachusetts; Infectious Diseases Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Carl G. Streed, Jr, MD
The Fenway Institute, Fenway Health, Boston, Massachusetts; Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts
Introduction: Approximately 2% of the U.S. population identifies as transgender, and transgender people experience disproportionate rates of cardiovascular disease mortality. However, widely used cardiovascular disease risk estimators have not been validated in this population. This study sought to determine the impact on statin therapy recommendations using 3 different approaches to operationalizing sex in the American Health Association/American College of Cardiology Pooled Cohort Equation Risk Estimator. Methods: This is a cross-sectional analysis of baseline clinical data from LITE Plus, a prospective cohort study of Black and/or Latina transgender women with HIV. Data were collected from October 2020 to June 2022 and used to calculate Pooled Cohort Equation scores. Results: The 102 participants had a mean age of 43 years. A total of 88% were Black, and 18% were Latina. A total of 79% were taking gender-affirming hormones. The average Pooled Cohort Equation risk score was 6% when sex assigned at birth was used and statins would be recommended for the 31% with Pooled Cohort Equation >7.5%. The average risk score was 4%, and 18% met the criteria for statin initiation when current gender was used; the mean risk score was 5%, and 22% met the criteria for statin initiation when current hormone therapy was used. Conclusions: Average Pooled Cohort Equation risk scores vary substantially depending on the approach to operationalizing the sex variable, suggesting that widely used cardiovascular risk estimators may be unreliable predictors of cardiovascular disease risk in transgender populations. Collection of sex, gender, and hormone use in longitudinal studies of cardiovascular health is needed to address this important limitation of current risk estimators.
