Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death with persistent disparities across social and demographic groups, including race and income. Recent research has focused on understanding cardiovascular risks and outcomes among marginalised populations, particularly sexual minorities (e.g., lesbian, gay, bisexual [LGB] adults), who face unique inequities compared to their heterosexual peers. As the visibility of LGB populations increases, addressing their cardiovascular health is a priority for clinicians, researchers, and public health officials.
Since most longitudinal cardiovascular studies lack data on sexual orientation, electronic health records (EHRs) have become a valuable resource for examining health disparities in marginalised groups. The Veterans Health Administration (VHA), the largest healthcare system in the U.S., offers comprehensive EHR data that can enhance understanding of veteran health, especially as veterans generally have higher rates of ASCVD and related risk behaviours (e.g., alcohol and tobacco use) compared to civilians. Despite the unique stressors faced by veterans, few studies have explored the cardiovascular health of sexual minority veterans.
To address this gap, researchers analysed data from over 1 million veterans receiving VHA care to assess whether sexual minority status is linked to higher ASCVD prevalence (including myocardial infarction, ischaemic stroke, and coronary revascularisation), accounting for both traditional risk factors and stressors specific to this population. These findings are published in the Journal of the American Heart Association.
The researchers reviewed 1,102,193 veterans who provided sexual orientation information, of whom 170,861 identified as LGB. They calculated statistics by sex and sexual orientation and conducted logistic regression to assess associations between sexual orientation and ASCVD prevalence.
After adjusting for factors such as age, sex, race, and Hispanic ethnicity, LGB veterans had a 1.24 times greater risk of ASCVD than non-LGB veterans. This increased risk remained significant even after accounting for additional ASCVD risk factors, substance use, anxiety, and depression. The study also found that LGB veterans, both male and female, had higher rates of smoking and alcohol use than their heterosexual peers.
This is one of the first studies examining cardiovascular risk factors and disease within the veteran population and shows that LGB veterans, as a group, had worse cardiovascular outcomes compared to their heterosexual peers.
With increasing visibility and acceptance of sexual minority groups, understanding and addressing cardiovascular health in older LGB adults is crucial. These findings also highlight the need for targeted tobacco cessation efforts to improve health outcomes for sexual minority individuals. Similarly, alcohol use disorders were more prevalent among LGB veterans, often used as coping mechanisms for stress.
Source: Boston University School of Medicine
Image Credit: iStock
References:
Streed CG et al. (2024) Prevalent Atherosclerotic Cardiovascular Disease Among Veterans by Sexual Orientation. Journal of the American Heart Association.
