ACC 2023: Hormone Therapy for People With Gender Dysphoria May Increase Risk for Cardiac Events
Risk higher for ischemic stroke, ST elevation myocardial infarction, and pulmonary embolism compared with never use
MONDAY, March 13, 2023 (HealthDay News) – Use of hormone therapy for people with gender dysphoria may increase the risk for cardiac events, according to research presented at the annual meeting of the American College of Cardiology together with the World Congress of Cardiology, held from March 4 to 6 in New Orleans.
“Starting hormone replacement therapy or gender-affirming hormone therapy is not a risk-free endeavor, and there are risks as well as benefits with undergoing this therapy. We believe that a thorough review of risks and benefits should be had between a patient and their physician,” Ibrahim Ahmed, M.D., of Mercy Catholic Medical Center in Philadelphia, told Elsevier’s PracticeUpdate.
Ahmed and colleagues performed a retroactive chart review using the 2019 Nationwide Inpatient Sample database to identify adults with a diagnosis of gender dysphoria and use of hormone replacement therapy. They identified a total of 21,335 gender dysphoria patients, of whom 1,675 underwent hormone therapy.
The researchers found that hormone replacement therapy was significantly associated with ischemic stroke (odds ratio [OR], 7.15; 95 percent confidence interval [CI], 2.74 to 18.67; P < 0.001), pulmonary embolism (OR, 4.92; 95 percent CI, 2.08 to 11.62; P < 0.001), ST elevation myocardial infarction (OR, 5.90; 95 percent CI, 1.07 to 32.42; P < 0.05), and non-ST-elevation myocardial infarction (OR, 3.30; 95 percent CI, 1.20 to 9.04; P < 0.05). Hormone replacement therapy was not significantly associated with atrial fibrillation (OR, 0.48; 95 percent CI, 0.18 to 1.32; P = 0.155), diabetes mellitus (OR, 0.90; 95 percent CI, 0.49 to 1.64; P = 0.727), hypertension (OR, 1.23; 95 percent CI, 0.88 to 1.72; P = 0.217), hemorrhagic stroke (OR, 2.36; 95 percent CI, 0.51 to 10.98; P = 0.275), or systolic heart failure (OR, 1.62; 95 percent CI, 0.72 to 3.69; P = 0.246).
Those taking hormone replacement therapy had similar all-cause mortality rates (0.60 versus 0.48 percent; P = 0.7741), mean length of stay (5.71 versus 6.09 days; P = 0.321), and mean total hospitalization charge ($61,011.71 versus $49,930.34; P = 0.598) as the non-hormone replacement therapy cohort.
“There is very little research in patients with gender dysphoria taking hormone replacement therapy, which I believe is contributing to the health disparities that exist in this community,” Ahmed told Elsevier’s PracticeUpdate.
He added that future research should focus on the best route of administration for hormone therapy, as some research has shown that oral estrogen confers a higher risk for venous thromboembolism compared with transdermal administration in biologic women. “By studying different routes of administration, we can best choose a route of administration that reduces cardiovascular risks the most,” he concluded.
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