ImportanceResearch on the cardiovascular health (CVH) of sexual minority adults has primarily examined differences in the prevalence of individual CVH metrics rather than comprehensive measures, which has limited development of behavioral interventions.ObjectiveTo investigate sexual identity differences in CVH, measured using the American Heart Association’s revised measure of ideal CVH, among adults in the US.Design, Setting, and ParticipantsThis cross-sectional study analyzed population-based data from the National Health and Nutrition Examination Survey (NHANES; 2007-2016) in June 2022. Participants included noninstitutional adults aged 18 to 59 years. We excluded individuals who were pregnant at the time of their interview and those with a history of atherosclerotic cardiovascular disease or heart failure.ExposuresSelf-identified sexual identity categorized as heterosexual, gay/lesbian, bisexual, or something else.Main Outcomes and MeasuresThe main outcome was ideal CVH (assessed using questionnaire, dietary, and physical examination data). Participants received a score from 0 to 100 for each CVH metric, with higher scores indicating a more favorable CVH profile. An unweighted average was calculated to determine cumulative CVH (range, 0-100), which was recoded as low, moderate, or high. Sex-stratified regression models were performed to examine sexual identity differences in CVH metrics, disease awareness, and medication use.ResultsThe sample included 12 180 participants (mean [SD] age, 39.6 [11.7] years; 6147 male individuals [50.5%]). Lesbian (B = −17.21; 95% CI, −31.98 to −2.44) and bisexual (B = −13.76; 95% CI, −20.54 to −6.99) female individuals had less favorable nicotine scores than heterosexual female individuals. Bisexual female individuals had less favorable body mass index scores (B = −7.47; 95% CI, −12.89 to −1.97) and lower cumulative ideal CVH scores (B = −2.59; 95% CI, −4.84 to −0.33) than heterosexual female individuals. Compared with heterosexual male individuals, gay male individuals had less favorable nicotine scores (B = −11.43; 95% CI, −21.87 to −0.99) but more favorable diet (B = 9.65; 95% CI, 2.38-16.92), body mass index (B = 9.75; 95% CI, 1.25-18.25), and glycemic status scores (B = 5.28; 95% CI, 0.59-9.97). Bisexual male individuals were twice as likely as heterosexual male individuals to report a diagnosis of hypertension (adjusted odds ratio [aOR], 1.98; 95% CI, 1.10-3.56) and use of antihypertensive medication (aOR, 2.20; 95% CI, 1.12-4.32). No differences in CVH were found between participants who reported their sexual identity as something else and heterosexual participants.Conclusion and RelevanceResults of this cross-sectional study suggest that bisexual female individuals had worse cumulative CVH scores than heterosexual female individuals, whereas gay male individuals generally had better CVH than heterosexual male individuals. There is a need for tailored interventions to improve the CVH of sexual minority adults, particularly bisexual female individuals. Future longitudinal research is needed to examine factors that might contribute to CVH disparities among bisexual female individuals.

Introduction: There is growing evidence that sexual minority (e.g., lesbian, gay, bisexual) adults are at higher risk of cardiovascular disease (CVD) than heterosexual adults. Research on the cardiovascular health (CVH) of sexual minority adults has primarily examined differences in the prevalence of individual CVH metrics rather than comprehensive measures. Therefore, we investigated sexual identity differences in ideal CVH among adults (ages 18-59) in the United States using the American Heart Association’s (AHA) Life’s Simple 7; a composite measure of ideal CVH. Methods: We analyzed cross-sectional data from the National Health and Nutrition Examination Survey (2007-2016). Questionnaire, dietary, and physical examination data were used to assess the seven metrics included in the Life's Simple 7 measure. Participants received a score of 0 (poor), 1 (intermediate), or 2 (ideal) for each CVH metric and scores were summed to calculate ideal CVH scores (continuous; range 0-14). We ran sex-stratified regression models adjusted for demographic characteristics and survey year to examine sexual identity differences in ideal CVH scores and ideal CVH (i.e., odds of meeting ideal criteria for ≥5 CVH metrics). Results: The sample included 12,832 participants with a mean age of 39.2 (±11.95) of which 5.7% were sexual minority. Compared to heterosexual women, bisexual women had lower ideal CVH scores ( B = -0.65, 95% CI = -1.02, -0.27) and they were also less likely to meet criteria for ideal CVH (AOR = 0.66, 95% CI = 0.47-0.93). Gay men had higher ideal CVH scores than heterosexual men ( B = 0.61 95% CI = 0.01, 1.21). Gay (AOR = 2.05, 95% CI = 1.16-3.62) and bisexual (AOR = 2.15, 95% CI = 1.16-3.99) men were more likely than heterosexual men to meet criteria for ideal CVH. Conclusions: This is the first representative study to investigate sexual identity differences in ideal CVH. Bisexual women were at higher risk of CVD than heterosexual women, which was attributed to higher odds of current tobacco use and obesity. Gay and bisexual men were at lower risk of CVD than heterosexual men. Future longitudinal research is needed to examine factors that might contribute to CVH disparities among bisexual women. Clinical interventions to reduce CVD risk among bisexual women are needed.

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