June is Pride Month, a time to recognize and celebrate the LGBTQ community. Each June, people across the country come together to honor LGBTQ culture and support the community’s rights. And although the LGBTQ population receives a lot of attention during Pride Month, there is one aspect that often goes unnoticed — their heart health.
According to a scientific statement from the American Heart Association, published in October 2020, that examined health care discrimination faced by the LGBTQ community, 56% of LGBTQ adults said they experienced some form of discrimination from clinicians (including the use of harsh/abusive language), and that number jumps to 70% for transgender or gender non-conforming people. In the health and medical community, LGBTQ orientation is considered a “sexual minority,” and transgender or gender-nonconforming is considered a “gender minority.”
The statement looks at existing research about LGBTQ disparities in cardiovascular health and provides suggestions for improving the research and care of LGBTQ people.
There are seven risk factors that can lead to heart disease: smoking, obesity or being overweight, physical inactivity, unhealthy eating habits, uncontrolled blood cholesterol, blood pressure and/or blood sugar.
“While there’s limited information on the cardiovascular health of LGBTQ people, a few risk factors stand out from existing data. Due to mental health stressors such as family rejection and anxiety over concealing sexual orientation or gender identity, members of the LGBTQ community are particularly vulnerable to increased tobacco and substance use compared to heterosexual people. In fact, sexual minority women are more likely to use tobacco than heterosexual women and men and sexual minority men. These lifestyle habits can lead to weight gain, hypertension and increased blood sugar levels, which all play a significant role in your heart health,” said Dr. Suzanne Steinbaum, volunteer medical expert for American Heart Association’s Go Red for Women movement and cardiologist in New York City.
Lesbian, gay, bisexual and transgender adults smoke at rates up to 2.5 times higher than straight adults. And more than half of LGBTQ teens have experimented with cigarettes, compared to just under 30% of straight teens, according to Philly Pride. In addition to social stressors driving these rates, the tobacco industry has historically targeted LGBTQ communities through the sponsorship of LGBTQ organizations and promotion of tobacco products in social settings, according to the William Way LGBT Community Center. Transgender and nonbinary people are also more likely to binge drink than their cisgender peers.
Other health factors also impact the LGBTQ population. Lesbian and bisexual women have a higher prevalence of obesity, according to the American Heart Association. In addition, many transgender people who receive hormone therapy have unaddressed heart disease risk factors such as high blood pressure and cholesterol, according to the American Heart Association. This is due in part to the fact that transgender individuals are less likely to have access to health care or to delay doctor visits for a variety of reasons, including stigma and fear of mistreatment.
“Patients from the LGBTQ community report experiencing forms of discrimination like harsh or abusive language from health care professionals,” adds Dr. Steinbaum. “For a community already exposed to psychological and social stressors in their daily life, including violence, job and housing discrimination, the anxiety surrounding a consultation with a medical professional, whether it’s for preventative or treatment reasons, keep them from taking care of health issues or getting screened. The consequences of any delay, combined with lifestyle choices like smoking and inactivity, include increased risk for heart disease and stroke.”
Improving the cardiovascular health of the LGBTQ population requires policy changes within health care education and clinical settings. It will require a multi-faceted approach comprising researchers, clinicians and public health officials, according to the scientific statement.
Competitive soccer player Lindsey Huie, a member of the LGBTQ community, understands the risk LGBTQ individuals face. She is a heart disease survivor, diagnosed at age 36 with spontaneous coronary artery dissection, or SCAD. The condition is a tear in an artery wall of the heart that requires emergency treatment.
Huie, who ate well and stayed active, never would have imagined she was at risk for a heart condition. But stress, including multiple work and life commitments, likely contributed to it, according to her doctor. She also delayed treatment because she said, she didn’t want to “make a big deal out of nothing.”
Today, she cautions others in the LGBTQ community to pay close attention to their heart health.
“As a member offer LGBT+ community I have to acknowledge that the stress I experience in coming out in every new situation and with every new person is real. This includes medical appointments, staff, facilities, you just never know how being a part of the LGBTQ+ community will be received. I never want that stress and maybe fear to deter myself or others from seeking the care we need,” Huie said.
Studies show that proper social support can help offset increased heart disease and stroke risks in the LGBTQ population. Researchers urge health care professionals to ask patients about their exposure to discrimination and whether they have adequate support to deal with the stressors.
To learn more about health care discrimination in the LGBTQ community and how it contributes to poor health outcomes, visit heart.org.
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