ArticleJournal of general internal medicine2025
Incident Atherosclerotic Cardiovascular Disease Among Veterans by Gender Identity: A Cohort Study.
Article in Journal of general internal medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Cardiometabolic diseases in transgender populations.Cardiovascular diabetology. Endocrinology reports · 2026Review
- Inclusive cardiovascular care for sexual and gender minority populations.Nature reviews. Cardiology · 2026Article
- Twenty years of sex and gender science in health research: a policy statement from the Organization for the Study of Sex Differences.Biology of sex differences · 2026Review
- Sexual orientation, gender identity and cardiometabolic risk: a narrative review.Diabetologia · 2025Review
Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
backgroundTransgender and gender diverse (trans) populations are at elevated risk for atherosclerotic cardiovascular disease (ASCVD).
objectiveMeasure the association of gender identity and gender-affirming hormone therapy (GAHT) with ASCVD outcomes.
designCohort study.
participantsOver 1 million veterans receiving care in the Veterans Health Administration. MAIN MEASURES: Gender identity was identified via a validated natural language processing (NLP) algorithm. Incident ASCVD (acute myocardial infarction, ischemic stroke, or revascularization after the baseline date) was identified via International Classification of Diseases diagnosis codes among veterans without prevalent ASCVD. We calculated sample statistics stratified by gender identity and used Cox proportional hazard regression to assess associations of gender identity and GAHT with incident ASCVD. KEY
resultsAmong 1,105,082 veterans, 42,149 were classified as trans (8013 transfeminine, 7127 transmasculine, and 27,009 uncategorized trans) while 918,843 were cisgender men and 144,090 were cisgender women. During a median follow-up of 9.39 years, 92,910 veterans had incident ASCVD (2806 among trans veterans). Adjusting for age, race, Hispanic ethnicity, and sexual orientation, trans veterans had 1.52 [1.45, 1.59] and 0.92 [0.89, 0.96] times the hazard of ASCVD compared to cisgender women and cisgender men, respectively. Compared to trans veterans not receiving GAHT, GAHT among trans veterans assigned female at birth was significantly associated a reduced hazard of ASCVD (0.89 [0.80, 0.98]); GAHT was not associated with ASCVD among trans veterans assigned male at birth (0.99 [0.89, 1.09]). LIMITATIONS: With NLP, there is potential for selection bias as clinicians may preferentially document the gender identity for trans more than cisgender veterans.
conclusionsThis is one of the first studies to examine the association of both gender identity and GAHT with incident ASCVD in veterans. Future research must comprehensively evaluate ASCVD outcomes and the effects of gender-affirming care (including hormone therapy) in trans populations.
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