Friday, June 14, 2019
AHA News: Are Transgender Men and Women Who Take Hormones at Risk for Heart Disease?
FRIDAY, June 14, 2019 (American Heart Association News) -- The impact of hormone therapy on the heart health of transgender men and women has been the subject of several studies
ed within the last year. But medical experts and researchers aren't ready to sound the alarm just yet.
"We have to recognize that hormones can be lifesaving therapy for trans people," said Dr. Richard Greene, an associate professor at New York University School of Medicine. "The answer is figuring out how to give them safely and how to modify some of these cardiovascular risk factors in the best way possible."
One study found that transgender women who take hormones were more than twice as likely to have a stroke and deep vein clots compared to cisgender men and women -- or people who identify as the sex they were assigned at birth. In addition, both trans women and trans men had a higher risk of heart attack than cisgender women.
Still, the findings aren't enough reason for doctors to stop prescribing hormones -- primarily estrogen to transgender women and testosterone to transgender men. Greene said he found some of the science behind the more recent research "problematic."
Many of the studies don't ask how long a person has identified as transgender or consider the kinds of hormones being used. Some older types of estrogen are associated with higher risk for stroke, he said. In addition, most studies did not ask whether the individuals taking hormones considered themselves non-binary, or not identifying as either man or woman.
But Greene applauded the overall focus of the latest research and described the studies as significant.
"What's amazing is that we're actually asking a question about trans people and their health that's not about their gender and not about their psychosocial well-being," he said. "We're asking questions that say trans people are in our clinics and are in our health care system, and we need to take the best evidence-based care of them that we can."
He said transgender individuals undergoing hormone therapy can best reduce their cardiovascular risks through heart-healthy basics and by meeting regularly with a primary care physician.
Transgender individuals, however, don't engage in preventive care at the same rate as cisgender people, primarily because they fear discrimination or lack resources and easy access.
"There are certainly plenty of (trans) people who only see an endocrinologist for hormones and don't have other medical providers engaged in their care," said Zil Goldstein, a family nurse practitioner and the associate medical director at New York's Callen-Lorde Community Health Center. "That means there's not really anyone whose job it is to focus on things like getting a flu vaccine, or getting cholesterol and health screenings."
Goldstein said transgender patients also should be screened for substance abuse, depression and psychological distress, all contributors to heart disease.
Greene agreed. He said recent research has helped raise awareness among some medical professionals.
"Have that conversation with a trans person in primary care and say, 'Let's talk about how we can get you to quit smoking.' Talk to them about their weight, about their diabetes, about their high blood pressure, their cholesterol – all those things are going to make the biggest difference in someone's cardiac risk when we get to the bottom line," Greene said.
"Real engagement with the health care system and engagement with good quality primary care that's affirming for trans people is the most important thing people can do."
Goldstein said more long-term research is needed to provide additional insights into the cardiovascular health of transgender men and women.
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Next time you're ready to hit the sofa for an evening of TV, think twice -- it just might kill you.
ReplyDeleteThough too much sitting has long been linked to health risks, a new study suggests all sitting isn't the same -- and sitting in front of the TV after dinner for long hours at a stretch is especially unhealthy.
In fact, those who did just that increased their risk for heart attack, stroke and early death by 50% compared to those who didn't, researchers report.
"It's the combination of dinner and sitting on the couch watching TV for hours afterward that we think can be very toxic," said lead researcher Keith Diaz, an assistant professor of behavioral medicine at Columbia University Vagelos College of Physicians and Surgeons in New York City.
Sitting in front of the TV is different from sitting at work, he said.
"At work, we get up and move often -- we go to a coworker's desk, we go to the bathroom, to the copy machine, etcetera," Diaz said. "But when we sit and watch TV, we tend not to move for hours at a time. That type of sitting is the most hazardous type of sitting."
Hours spent in front of the TV after dinner increase blood sugar and cholesterol. And because muscles are inactive, they don't help clear away the sugar and fat from blood vessels. Diaz suspects this is what make this type of sitting so lethal.
Although all participants in the study were black, Diaz said the findings probably apply to all groups.
He cautioned, though, that the study doesn't prove that sitting for long, uninterrupted periods causes heart attacks or stroke or premature death, only that there's a link.
"The last thing you should do after a big meal is sit down and watch TV for hours," Diaz said. "Go out for a 10- to 20-minute walk and then sit down."
The study followed nearly 3,600 Mississippians for almost nine years. Participants reported how much time they typically spent sitting while watching TV and doing work. They also reported on their exercise habits.
Those who watched TV four hours or more a day had a 50% higher risk for heart attack, stroke and early death, compared with those whose TV time was less than two hours a day, the study found.
Surprisingly, those who sat for long periods on the job had the same risk for heart disease and early death as those who sat the least, the researchers found.
But even the most devoted couch potatoes could reduce their risk by getting a little exercise, Diaz said.
For those who watched a lot of TV, exercising for at least 150 minutes a week removed the added health risk.
"These findings reinforce current recommendations to reduce time spent sitting and to engage in at least 150 minutes per week of moderate intensity aerobic activity spread throughout the week," said Dr. Gregg Fonarow, a American Heart Association spokesman and professor of cardiology at the University of California, Los Angeles.
Moderate intensity aerobic activities include brisk walking (at least 2.5 miles per hour), dancing, gardening, doubles tennis and biking, he said.
"Even light intensity physical activity can offset some of the risks of being sedentary," Fonarow added. "These findings reinforce the advice to 'move more and sit less.' "
The findings were published online June 26 in the Journal of the American Heart Association.