Cardiovascular Risks Among the Transgender Population in Rural United States: Spotlight on the Appalachian Region

Background Gender diverse populations have disproportionately worse cardiovascular (CV) outcomes. However, the data on the prevalence of cardiovascular risk factors among the transgender population in rural Appalachia remains limited. The purpose of this study was to determine the prevalence of CV risk factors among the transgender population in rural Appalachia. Methods This retrospective case-control study from an Appalachian university teaching hospital clinic matched transgender individuals with controls from the same clinic. Logistic regression model was performed to determine the prevalence of CV risk factors among the transgender population in comparison to their cisgender counterparts. Results The total number of transgender and cisgender individuals identified were 89 and 69, respectively. After adjusting for age and family history of atherosclerotic CV disease, transgender status remained independently associated with tobacco use (adjusted odds ratio [aOR] 6.64 [2.59-17.01]) and prediabetes/diabetes mellitus (aOR 3.98 [1.05-15.15]). Among the transgender population, there were increased odds of obesity (aOR 13.39 [3.30-54.30] and hyperlipidemia (aOR 3.46 [1.03-11.59]) in the transgender male group compared to the transgender female group. In another subgroup analysis, transgender individuals who underwent surgical and/or hormonal treatment had significantly higher odds of tobacco use (aOR 6.67 [2.80-15.98]), statin need (aOR 3.97 [1.14-13.81], and alcohol use (aOR 11.31 [1.34-95.53]). Increased statin use tends to be associated with normal LDL levels. Conclusions In rural Appalachia, transgender status is associated with disproportionately higher odds of tobacco use, elevated blood glucose and other CV risk factors.