Cardiovascular Risk Among Transgender Persons Initiating Gender-Affirming Hormone Therapy

Four white pills and a pill bottle
Four white pills and a pill bottle
Transgender persons who present for gender-affirming hormone therapy may be at an elevated cardiovascular risk.

This article is part of Cardiology Advisor‘s coverage of AHA Scientific Sessions 2020.

Transgender persons who present for gender-affirming hormone therapy (GAHT) may be at an elevated cardiovascular (CV) risk, according to study results presented at the American Heart Association (AHA) Scientific Sessions 2020, held virtually from November 13 to 17, 2020.1

In this retrospective study, data from transgender patients (n=427; median age, 26 years; 55.6% assigned male sex at birth; 55.4% with a chronic medical condition) were examined. Study participants were seeking to initiate GAHT at a multidisciplinary transgender program. American College of Cardiology/American Heart Association atherosclerotic cardiovascular disease (ASCVD) and QRISK3 risk scores were calculated for all patients who did not have documented CV disease.

In this cohort, the incidence of undiagnosed hypertension was 6.8%, and the incidence of undiagnosed hyperlipidemia was 11.3%. Of these groups, 64.4% and 24.1% of patients, respectively, were on appropriate therapies.

The mean ASCVD risk and QRISK3 among participants ages 40 to 65 years were 8.3% and 12.2%, respectively. The mean QRISK3 among patients ages 25 to 39 years was 4.6%.

Of participants who had been diagnosed with high blood pressure, more than one-third had not been receiving recommended treatment. Of patients who already had been diagnosed with high cholesterol, more than three-quarters had not been receiving recommended treatment. In addition, 56.5% of participants had previously been diagnosed with a mental health disorder, including anxiety or depression.

“When we calculated the risk of developing a heart attack or stroke over 10 years, the risk for transgender men and women was higher than that reported for the average American of their age and gender,” noted Kara J. Denby, MD, lead study author and a clinical fellow in cardiovascular medicine at the Cleveland Clinic Foundation in Cleveland, Ohio.2 “We also found that, even in the highest risk individuals, many were not receiving recommended treatment.”

Study limitations include its retrospective design, and the inability to establish a causal relationship transgender status and the presence of heart disease risk factors.

“Transgender individuals face numerous barriers and biases to access the health care they need,” Dr Denby commented.2 “We owe it to them to improve access and care so they can improve their CV disease health and overall well-being. Policies and healthcare structures that are safe and supportive are critical for the transgender population to achieve health equity.”

Disclosures: One of the study authors reported affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.


  1. Denby KJ, Patil M, Toljan K, et al. Cardiovascular risk at presentation for gender-affirming care in the transgender population. Presented at: AHA Scientific Sessions 2020; November 13-17, 2020. Presentation P2274.
  2. Many transgender people who receive hormone therapy have unaddressed heart disease risks [press release]. Dallas, Texas: American Heart Association; November 9, 2020.

Visit Cardiology Advisor‘s conference section for continuous coverage from AHA 2020.