Lesbian, Bisexual Women Had Lower Heart Health

According to new research published in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association, lesbian and bisexual women were less likely to have ideal cardiovascular health scores compared to heterosexual women, making them a priority group for cardiovascular disease prevention.

In comparison to their straight male counterparts, gay and bisexual males were more likely to have optimal cardiovascular health scores. The findings come from a study that found differences in heart health among sexual minority people in France, as measured by the American Heart Association’s Life’s Essential 8 and Life’s Simple 7 criteria for ideal cardiovascular health.

The study is the first to look at cardiovascular health disparities among people who identify as a sexual minority group, as defined by self-reported lifetime sexual behavior and classified as lesbian, gay, bisexual, or heterosexual. It is also likely the first study to assess cardiovascular health among sexual minority groups using the American Heart Association’s cardiovascular health criteria. Life’s Essential 8 was modified in 2022 to include healthy sleep as a cardiovascular health factor in addition to the initial 7 metrics in Life’s Simple 7: healthy food; regular physical exercise; no smoking; healthy weight; and normal blood sugar, cholesterol, and blood pressure levels.

“Improving these metrics is a great opportunity to prevent heart problems before they happen,” said lead study author Omar Deraz, D.M.D., M.P.H., Ph.D.-candidate affiliated with Université Paris Cité, Inserm (French National Institute of Health and Medical Research) and the Paris Cardiovascular Research Center’s Integrative Epidemiology of Cardiovascular Disease Team. “We wanted to see if there are differences in Life’s Essential 8 cardiovascular health scores in sexual minority individuals, including gay, lesbian and bisexual adults, compared to heterosexual individuals.

“Improving cultural competency and awareness of cardiovascular disease risk among sexual minority adults may help to improve conversations between doctors and patients about cardiovascular health, including prevention and management,” Deraz said. “Understanding and overcoming barriers to health care access are essential to improve cardiovascular disease prevention and care in sexual minorities.”

According to the report, prior research has revealed that sexual minority people are less likely to obtain health care and are more likely to postpone health treatment than heterosexual adults.

The study assessed health data from over 169,400 persons (average age 46 years; 54% women) without cardiovascular disease who took part in the CONSTANCES (CONSulTANts des Centres d’Examens de Santé) countrywide study in France. From 2012 to 2020, participants were recruited at random for the study, which looked at risk factors for chronic disease and aging, including cardiovascular disease. Participants went to one of 24 health centers in 21 cities across France and Europe, where they had clinical examinations and laboratory tests at the start of the study and then every four years.

Among the almost 91,000 women who took part in the study, 93% identified as heterosexual, 3.5% as bisexual, and less than 1% (0.61%) as lesbian. The survey included about 78,550 men, 90% of whom identified as heterosexual, 3.5% as bisexual, and 3% as gay. Approximately 3% of women and 3% of men did not respond to questions concerning their sexual behavior.

After controlling for a variety of characteristics such as family history of cardiovascular disease, age, and socioeconomic factors, the study discovered:

• Lesbian and bisexual women reported considerably lower cardiovascular health scores than heterosexual women when utilizing Life’s Essential 8 criteria, 0.95 and 0.78 points lower, respectively. Lesbian women, on the other hand, had better cardiovascular health than heterosexual women among women who had ever been pregnant.
• When compared to heterosexual men, gay and bisexual men had 2.72 and 0.83 points higher cardiovascular health scores. Sexual minority men in rural areas, on the other hand, had lower cardiovascular health scores (average Life’s Essential 8 score around 61) than their urban counterparts (average Life’s Essential 8 score around 66) and were less likely to achieve ideal cardiovascular health than their heterosexual counterparts.
• Lesbian women scored lower on Life’s Essential 8 for healthy nutrition and blood pressure levels when compared to heterosexual women. Bisexual women, on the other hand, received higher marks for healthy eating and nicotine exposure.
• Cardiovascular health scores were consistent with Life’s Essential 8 scores across all participant groups when tested using Life’s Simple 7 metrics, however the variations were less.

Previous study has identified lifestyle risk factors for cardiovascular disease, such as nutrition and physical exercise, in adults who identify as sexual minorities. According to the study authors, few studies have focused on health parameters such as blood sugar, blood pressure, and cholesterol.

Previous research has found that sexual minority communities are disproportionately affected by mental health issues such as depression and suicide attempts, which have been related to an increased risk of cardiovascular disease. Furthermore, bias-motivated discrimination and violence, together with increasing societal stresses, may lead to unhealthy coping habits such as increased alcohol use, smoking, and a sedentary lifestyle.

In this study, lesbian, bisexual, and homosexual participants’ demographic and socioeconomic determinants of health were compared to heterosexual ones:

• When compared to their heterosexual peers, sexual minority adults were younger, less likely to be self-employed or work in a managerial position, had higher education levels defined as at least two years of education beyond high school, were less likely to live with a partner, lived in poverty or in urban areas more frequently, and had patterns of excessive alcohol consumption.
• Sexual minority adults were more likely than heterosexual people to report mental health concerns such as anxiety disorders, depressive symptoms, taking prescription drugs for depression, or a history of suicide attempts. Lesbian women, on the other hand, experienced fewer anxiety and sadness symptoms than heterosexual women.

“In view of previous evidence, these findings may be explained at least partially by living conditions, such as poverty, degraded working conditions, mental health challenges, discrimination and/or bad past experiences in the health system,” Deraz said.

A 2020 American Heart Association scientific statement “Assessing and Addressing Cardiovascular Health in LGBTQ Adults,” noted that LGBTQ adults experience significant psychosocial stressors that compromise their cardiovascular health across the life span.

Because France is a high-income country with universal health care, the conclusions of this study should not be extended to other countries. Other limitations of the study included its exclusive focus on assessing cardiovascular health based on sexual minority identification, as well as the fact that it did not contain data on cardiovascular health for persons who identified as transgender because no data were available at the time of the study, according to the researchers.

“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,” said volunteer chair of the American Heart Association’s 2023 Statistical Update writing group Connie W. Tsao, M.D., M.P.H., FAHA, an assistant professor of medicine at Harvard Medical School and attending staff cardiologist at Beth Israel Deaconess Medical Center in Boston.

“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,” Tsao said. “This year’s Statistical Update writing group made a concerted effort to include the limited research on social and demographic factors related to health risk and outcomes, including sexual orientation and gender identity. We are hopeful that studies like this one will help to fill this gap in our knowledge about cardiovascular health among sexual minority populations, which is essential to the American Heart Association’s mission to improve cardiovascular health equity for all people.”

Future study, according to Deraz and co-authors, should incorporate social demographics such as sexual orientation, sex, gender identity, and gender expression, as well as continuing to investigate the relationship between cardiovascular health scores and heart disease risk among sexual minority communities.

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