Abstract 11944: Atherosclerotic Cardiovascular Disease Among Insured Adults by Gender Identity

Background: Atherosclerotic cardiovascular disease (ASCVD) risk is significantly affected by sex; however, the increasing impact of gender identify is unclear.

Hypothesis: We hypothesized that transgender and gender diverse (TGD) adults had higher prevalence of ASCVD risk factors and higher incidence of ASCVD outcomes compared to cisgender persons.

Methods: We used a large claims-based dataset (Optum’s de-identified Clinformatics® Data Mart Database) to conduct a cohort study of ASCVD risk and morbidity. We used a validated algorithm to identify TGD persons. Covariates included age, sex, race and ethnicity; ASCVD risk factors (e.g., hypertension); socioeconomic factors (e.g., education). We examined incidence and hazard ratios (HRs) of ischemic stroke (IS), myocardial infarction (MI), and coronary revascularization by gender identity in multivariable models.

Results: We identified 85,282 TGD adults from 2010-2022 and frequency matched them to 414,590 cisgender referents (1:5 ratio). Incidence of MI, IS, and revascularization ( Table 1 ) for TGD persons assigned male at birth over 50 years of age were 18.90, 32.16, and 9.88 per 1000 persons-years, respectively. For TGD persons assigned female at birth over 50 years of age, incidence of MI, IS, and revascularization was 8.37, 15.21, and 4.61 per 1000 persons-years, respectively. Accounting for demographic characteristics, ASCVD risk factors, and socioeconomic status, the HRs for TGD persons assigned male at birth compared to cisgender women for MI, IS, and revascularization were 2.02, 0.93, and 4.30, respectively. HRs for TGD persons assigned female at birth compared to cisgender men for MI, IS, and revascularization were 0.89, 0.70, 1.64, respectively.

Conclusion: We identified significant differences in ASCVD risk and morbidity by gender identity. Further research is needed to identify intervenable targets to improve the cardiovascular health of TGD populations.