DOI: 10.1161/circ.148.suppl_1.11950 ISSN: 0009-7322

Abstract 11950: Cardiometabolic Health Disparities in Sexual Minority Men

Humberto López Castillo, Christopher W Blackwell, Omar Martínez
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Aim: We summarize 3 meta-analyses conducted on hypertension, dyslipidemias, and obesity, comparing sexual minority men (SMM) and heterosexual men.

Methods: We conducted a systematic search in 4 databases to identify studies comparing SMM and heterosexual men in measures for the three relevant outcomes. Prevalence rates, continuous, and inverse variance estimates were generated through random effect models and reported through proportions, mean differences (MDs), and odds ratios (ORs), respectively, with their corresponding 95% confidence intervals [in brackets].

Results: Hypertension. 20 studies showed men who have sex with men (MSM) were less likely (OR 0.34 [0.16, 0.70]) whereas bisexual men were more likely (OR 2.25 [1.54, 3.28]) to report hypertension. Bisexual men are more likely to use antihypertensive medication (OR 1.44 [CI 1.11, 1.85]) and all SMM had higher diastolic blood pressure (DBP; MD 1.46 [1.38, 1.55] mmHg). Dyslipidemias. 10 eligible studies showed lower prevalence of elevated cholesterol for SMM (45.21%; χ 2 [1]=54.78; P <0.001) that does not hold with inverse variance analyses (OR 1.04 [0.91, 1.18]). While bisexual men—but not MSM—are more likely to take cholesterol-lowering medication (OR 1.47 [1.11, 1.93]) and present with lower cholesterol levels (MD –6.80 [–7.27, –6.34] mg/dL), MSM—but not bisexual men—present with lower triglyceride levels (MD –25.67 [–39.80, –11.55] mg/dL). Obesity. 43 studies identified lower prevalence of overweight, obesity, and elevated BMI among SMM, consistent with lower body mass index (BMI; MD –1.50 [–1.93, –1.08] kg/m 2 ) and decreased likelihood of overweight (OR 0.75 [0.64, 0.88]) and obesity (OR 0.84 [0.78, 0.90]).

Conclusions: SMM present more frequently with a history of hypertension, linked to elevated DBP—a marker of hypertension at earlier ages. Bisexual men are prescribed cholesterol-lowering medication and present with lower cholesterol levels; MSM present with lower triglyceride levels. Lower rates/likelihood of overweight, obesity, and elevated BMI may point to the obesity paradox—a sustained catabolic state presenting with lower BMI but poor cardiovascular outcomes—which, in connection to other stressors, warrants further research on cardiovascular disparities.

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