Cardiovascular disease and associated risk factors among transgender and gender diverse individuals.

BACKGROUND & OBJECTIVES: Although health disparities among transgender and gender diverse (TGD) individuals are increasingly recognized, the risks of cardiovascular disease in this population remain understudied. This multicenter analysis investigates whether TGD individuals face greater risk of cardiovascular disease and associated cardiometabolic risk factors compared to cisgender individuals. METHODS: Using data from a multicenter research network from 2010-2026, we propensity-score 1:1 matched TGD and cisgender individuals by age, sex assigned at birth, race, and ethnicity. We compared matched cohorts (n=36,052 per cohort) using risk ratios (RRs) with 95% confidence intervals (CIs). RESULTS: Compared to cisgender individuals, TGD individuals had greater risks of major adverse cardiovascular events (RR 1.23, 95% CI 1.11-1.35), ischemic heart disease (RR 1.29, 95% CI 1.17-1.43), acute myocardial infarction (RR 1.64, 95% CI 1.38-1.94), heart failure (RR 1.62, 95% CI 1.42-1.85), cardiomyopathy (RR 1.47, 95% CI 1.23-1.76), cardiac arrhythmias (RR 1.53, 95% CI 1.32-1.77), peripheral artery disease (RR 1.36, 95% CI 1.20-1.54), and venous thromboembolism (RR 1.36, 95% CI 1.18-1.57). TGD individuals also had greater risks of associated cardiometabolic risk factors: hypertension (RR 1.11, 95% CI 1.05-1.17), dyslipidemia (RR 1.24, 95% CI 1.19-1.29), pre-diabetes (RR 1.57, 95% CI 1.46-1.69), type II diabetes (RR 1.38, 95% CI 1.27-1.50), overweight or obesity (RR 1.35, 95% CI 1.31-1.39), tobacco use (RR 1.68, 95% CI 1.59-1.78), alcohol use disorder (RR 1.65, 95% CI 1.51-1.79), and insomnia (RR 2.36, 95% CI 2.24-2.49). CONCLUSION: TGD individuals demonstrate greater risks of numerous cardiovascular diseases and associated cardiometabolic risk factors. Additional longitudinal studies are warranted to further assess these differential risks.