LGBTQ adults face distinct threats to their heart health – and health care providers can do more to identify and thwart those risks, says a new report that aims to point the way toward better research and care.
The report, issued Thursday as a scientific statement from the American Heart Association, pulls together what scientists have learned about LGBTQ health, highlighting known problems and identifying gaps, said Dr. Nicole Rosendale, a member of the committee that wrote the report.
It aims to serve as a "one-stop shop" for heart health findings on a group that in the past has been "largely invisible within health care research and studies," said Rosendale, an assistant professor of neurology at the University of California, San Francisco.
Among the findings:
– Bisexual men have twice the odds of having high blood pressure as heterosexual men.
– LGBTQ adults, particularly women, are more likely to use tobacco than other adults.
– Gay men have similar or lower rates of obesity as heterosexual men, but lesbian and bisexual women tend to have higher obesity rates than heterosexual women.
– Short sleep duration, a risk factor for high blood pressure, diabetes and heart disease, is more common among lesbian and bisexual women than heterosexual women.
The scientific statement emphasizes that stress is thought to be a significant factor in health differences for LGBTQ people, said Billy A. Caceres, chair of the committee that wrote the report, published in the AHA journal Circulation. Some of those stressors are higher rates of poverty, especially in rural areas.
Also, "they experience things like discrimination, or fear of coming out to their family or even their health care providers, because they feel like they'll be treated differently," said Caceres, an assistant professor at Columbia University School of Nursing in New York. "And those things, on top of everything else that's stressful in life, probably place them at increased risk for poor health outcomes, including cardiovascular disease."
Many LGBTQ people in the United States had no legal protection from discrimination on the job until a U.S. Supreme Court ruling in June.
"At the interpersonal level, we can have the everyday experience of discrimination, where you either get called a name, where you get verbally harassed, or somebody treats you differently because of either your actual or perceived sexual orientation or gender identity," Caceres said.
That includes in doctors' offices. Many LGBTQ people report having experienced some form of discrimination, including the use of abusive language and denial of service, the report notes.
Stress in general is bad for the heart, and it can lead to unhealthy coping behaviors, such as smoking or overeating, which do damage over time, Caceres said. "It's not that you get discriminated against and then you all of a sudden develop hypertension, and then develop heart disease. It's that these are long-term, chronic stressors that you're repeatedly, as an LGBTQ person, exposed to."
But the exact links between stress and heart health are tangled, which is why the report calls for more research, especially in the areas where sexual orientation and race overlap. And to do such research, health care professionals need to ask their patients questions related to sexual orientation and gender identity.
Many health care workers are reluctant to do that, Caceres said.
"They feel that the patient's going to be put off by it," he said. "They feel that they're going to offend patients that are not LGBTQ. Or they feel that patients aren't going to be truthful."
But doing so as part of the routine gathering of demographic information, along with appropriate training for those gathering it, would provide data that could lead to better treatment, he and Rosendale said.
Meanwhile, health care providers could use the information in the report to provide better care right now, Rosendale said.
Knowing what the research says about, say, an LGBTQ person's higher risk of smoking, or of having a harder time affording a healthy diet, or living in an unsafe home because of discrimination could give a doctor important background knowledge for talking to a patient. It can help a doctor say, "I'm going to partner with you to help you be as healthy as possible" and come up with a plan, Rosendale said.
LGBTQ people as a group should not be thought of as fragile, she said. "I do think that there is an immense amount of resilience and strength within the LGBTQ community. Even just looking from a historical perspective. You know, we've been through a lot over the years and are still fighting in terms of getting equitable access to a number of basic rights – health care being one of them."
But understanding the connections between heart health, sexual orientation and gender identity is a basis for progress for LGBTQ people and everyone who cares for them, Rosendale said. "Knowledge is power, right?"
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