A Systematic Review of Cardiovascular Disease in Sexual Minorities

Abstract

Background: Mental health and HIV disparities are well documented among sexual minorities, but there is a dearth of research on other chronic conditions. Cardiovascular disease remains the leading cause of death worldwide. Although sexual minorities have high rates of several modifiable risk factors for cardiovascular disease (including stress, tobacco use, and alcohol consumption), there is a paucity of research in this area. Objectives: In this systematic review, we synthesized and critiqued the existing evidence on cardiovascular disease among sexual minority adults. Search Methods: We conducted a thorough literature search of 6 electronic databases for studies published between January 1985 and December 2015 that compared cardiovascular disease risk or prevalence between sexual minority and heterosexual adults. Selection Criteria: We included peer-reviewed English-language studies that compared cardiovascular disease risk or diagnoses between sexual minority and heterosexual individuals older than 18 years. We excluded reviews, case studies, and gray literature. A total of 31 studies met inclusion criteria. Data Collection and Analysis: At least 2 authors independently abstracted data from each study. We performed quality assessment of retrieved studies using the Crowe Critical Appraisal Tool. Main Results: Sexual minority women exhibited greater cardiovascular disease risk related to tobacco use, alcohol consumption, illicit drug use, poor mental health, and body mass index, whereas sexual minority men experienced excess risk related to tobacco use, illicit drug use, and poor mental health. We identified several limitations in the extant literature. The majority of included studies were cross-sectional analyses that used self-reported measures of cardiovascular disease. Even though we observed elevated cardiovascular disease risk, we found few differences in cardiovascular disease diagnoses (including hypertension, diabetes, and high cholesterol). Overall, 23 of the 26 studies that examined cardiovascular disease diagnoses used subjective measures. Only 7 studies used a combination of biomarkers and self-report measures to establish cardiovascular disease risk and diagnoses. Authors’ Conclusions: Social conditions appear to exert a negative effect on cardiovascular disease risk among sexual minorities. Although we found few differences in cardiovascular disease diagnoses, we identified an elevated risk for cardiovascular disease in both sexual minority men and women. There is a need for research that incorporates subjective and objective measures of cardiovascular disease risk. Public Health Implications: Cardiovascular disease is a major health concern for clinicians, public health practitioners, and policymakers. This systematic review supports the need for culturally appropriate interventions that address cardiovascular disease risk in sexual minority adults.

Real-time predictors of smoking among sexual minority and heterosexual young adults: An ecological momentary assessment study

“…There are likely a variety of factors influencing this growth, such as the increasing visibility in popular culture of individuals that are neither hetero- nor homosexual (e.g., pop stars and television show characters), which may increase the social acceptability of bisexual identity (Callis, 2014). The elevated smoking rates among sexual minorities coupled with lower access to healthcare (Trinh et al, 2017) lead to an increased risk for negative health consequences (e.g., cancer, respiratory illnesses, cardiovascular diseases) (Blosnich et al, 2013; Caceres et al, 2017). Moreover, tobacco use disparities among sexual minority individuals are likely established in smoking initiation during adolescence and young adulthood (Burkhalter, 2015; Corliss et al, 2013).…”

Racial/Ethnic Differences in Cardiometabolic Risk in a Community Sample of Sexual Minority Women

“…With a few exceptions, 55 there is a paucity of research examining racial/ ethnic differences in psychosocial and behavioral risk factors for CVD in SMW. 6 Future studies should use intersectional approaches to examine which subgroups of SMW are most at risk for CVD. We found that Black SMW had higher rates of obesity, hypertension, and diabetes than White SMW.…”

“…There is mounting evidence of higher car-diometabolic risk in sexual minority women (SMW; e.g., lesbian, bisexual) compared to heterosexual women. SMW have higher rates of poor mental health, [5][6][7][8] tobacco use, 6,[9][10][11] heavy drinking, 6,12,13 obesity, 8,[14][15][16][17][18] and hyperglycemia 15,19 that may predispose them to CVD relative to heterosexual women.…”

Culturally Competent Care of LGBT Patients: The NP Experience

“…Gay and bisexual men's health has focused primarily on prevention and treatment of sexually transmitted infection such as HIV as a result of the AIDS epidemic of the 1980s and early 1990s. However, gay, bisexual, or men who have sex with men (MSM) are at increased risk of other preventable conditions that have not received the same attention, including a higher incidence of smoking, which leads to an increased risk of cardiovascular disease, as well as lung and other cancers [12]. They also are more likely to experience mental health disorders, such as eating disorders, substance abuse, anxiety, depression, and suicidal ideation than their heterosexual counterparts [7].…”