Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov 19;13(22):e036898.
doi: 10.1161/JAHA.124.036898. Epub 2024 Nov 7.

Prevalent Atherosclerotic Cardiovascular Disease Among Veterans by Sexual Orientation

Carl G Streed Jr  1   2 , Meredith S Duncan  3 , Kory R Heier  3 , T Elizabeth Workman  4   5 , Lauren B Beach  6 , Billy A Caceres  7 , John R O'Leary  8   9 , Melissa Skanderson  8   9 , Joseph L Goulet  9   10
Affiliations

Prevalent Atherosclerotic Cardiovascular Disease Among Veterans by Sexual Orientation

Carl G Streed Jr et al. J Am Heart Assoc. .

Abstract

Background: Seven million lesbian, gay, and bisexual (LGB) adults will be aged >50 years by 2030; assessing and addressing their risk for cardiovascular disease is critical.

Methods and results: We analyzed a nationwide cohort using the Veterans Health Administration data. Sexual orientation (SO) was classified via a validated natural language processing algorithm. Prevalent atherosclerotic cardiovascular disease (ASCVD) (history of acute myocardial infarction, ischemic stroke, or revascularization) was identified via International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) codes. The index date was the date of the first primary care appointment on or after October 1, 2009. We ascertained covariates and prevalent ASCVD in the year following the index date; the baseline date was 1 year after the index date. We calculated sample statistics by sex and SO and used logistic regression analyses to assess associations between SO and prevalent ASCVD. Of 1 102 193 veterans with natural language processing-defined SO data, 170 861 were classified as LGB. Prevalent ASCVD was present among 25 031 (4105 LGB). Adjusting for age, sex, race, and Hispanic ethnicity, LGB veterans had 1.24 [1.19-1.28] greater odds of prevalent ASCVD versus non-LGB identified veterans. This association remained significant upon additional adjustment for the ASCVD risk factors substance use, anxiety, and depression (odds ratio [OR],1.17 [95% CI, 1.13-1.21]). Among a subset with self-reported SO, findings were consistent (OR, 1.53 [95% CI, 1.20-1.95]).

Conclusions: This is one of the first studies to examine cardiovascular risk factors and disease of the veteran population stratified by natural language processing-defined SO. Future research must explore psychological, behavioral, and physiological mechanisms that result in poorer cardiovascular health among LGB veterans.

Keywords: bisexual; cardiovascular; gay; heart attack; lesbian; sexual minority; veterans.

PubMed Disclaimer

Conflict of interest statement

Dr Streed reports salary support from Boston University Chobanian and Avedisian School of Medicine Department of Medicine Career Investment Award, American Heart Association career development grant (AHA 20CDA35320148), National Heart, Lung, and Blood Institute career development grant (NHLBI 1K01HL151902‐01A1), and Doris Duke Charitable Foundation (grant number 2022061). Dr Duncan reports salary support from the National Center for Advancing Translational Sciences, National Institutes of Health (KL2TR001996).

Dr Caceres reports salary support from National Heart, Lung, and Blood Institute career development grant (NHLBI K01HL146965). Dr Workman, J.R. O'Leary, M. Skanderson, and Dr Goulet report salary support from the Veterans Affairs Health Services Research and Development Services (IIR 18–035). The remaining authors have no disclosures to report.

Figures

Figure 1
Figure 1. Directed acyclic graph of association between sexual minority status and prevalent ASCVD.
ASCVD indicates atherosclerotic cardiovascular disease; and LGB, lesbian, gay, bisexual.
See this image and copyright information in PMC

References

    1. Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore‐Mensah Y, et al. Heart disease and stroke Statistics‐2022 update: a report from the American Heart Association. Circulation. 2022;145:e153–e639. doi: 10.1161/cir.0000000000001052 - DOI - PubMed
    1. Havranek EP, Mujahid MS, Barr DA, Blair IV, Cohen MS, Cruz‐Flores S, Davey‐Smith G, Dennison‐Himmelfarb CR, Lauer MS, Lockwood DW, et al. Social determinants of risk and outcomes for cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2015;132:873–898. doi: 10.1161/CIR.0000000000000228 - DOI - PubMed
    1. Caceres BA, Streed CG Jr, Corliss HL, Lloyd‐Jones DM, Matthews PA, Mukherjee M, Poteat T, Rosendale N, Ross LM; American Heart Association Council on Cardiovascular and Stroke Nursing; Council on Hypertension; Council on Lifestyle and Cardiometabolic Health; Council on Peripheral Vascular Disease; and Stroke Council ; et al. Assessing and addressing cardiovascular health in LGBTQ adults: a scientific statement from the American Heart Association. Circulation. 2020;142:e321–e332. doi: 10.1161/CIR.0000000000000914 - DOI - PMC - PubMed
    1. Caceres BA, Brody AA, Halkitis PN, Dorsen C, Yu G, Chyun DA. Sexual orientation differences in modifiable risk factors for cardiovascular disease and cardiovascular disease diagnoses in men. LGBT Health. 2018;5:284–294. doi: 10.1089/lgbt.2017.0220 - DOI - PMC - PubMed
    1. Caceres BA, Brody A, Luscombe RE, Primiano JE, Marusca P, Sitts EM, Chyun D. A systematic review of cardiovascular disease in sexual minorities. Am J Public Health. 2017;107:e13–e21. doi: 10.2105/AJPH.2016.303630 - DOI - PMC - PubMed

LinkOut - more resources