Cardiovascular Health Across Gender Identities: Life's Essential 8 in the PRIDE Study

BACKGROUND: Our objective was to assess the cardiovascular health of sexual and gender minority adults across the sex and gender spectrum. METHODS: This was a cross-sectional analysis of the American Heart Association Life's Essential 8 (LE8) score in sexual and gender minority adults in The PRIDE (Population Research in Identity and Disparities for Equality) Study. Using a validated algorithm, self-reported gender identity was categorized: cisgender men, cisgender women, gender-expansive people assigned female at birth, gender-expansive people assigned male at birth, transgender men, and transgender women. We used linear regression to calculate the mean composite LE8 score (primary outcome) and mean LE8 component scores (secondary outcome) across groups. RESULTS: Among the 4964 participants, the median age was 36.4 (interquartile range, 28.9-51.9) years, 49.7% (n=2398) were transgender or gender-expansive, and 1100 (22.2%) respondents used gender-affirming hormone therapy. Composite LE8 scores ranged from 70.3 (95% CI, 68.5-72.1) in transgender women to 72.9 (95% CI, 72.3-73.6) in gender-expansive people assigned female at birth, with no difference by gender-affirming hormone therapy use. Mean LE8 component scores differed significantly between groups, including a high prevalence of unfavorable body mass index scores in cisgender women and gender-expansive people assigned female at birth, unfavorable nicotine scores in gender-expansive people assigned male at birth and transgender men, and unfavorable sleep scores in transgender men and transgender women. Overall, participants had favorable physical activity and glucose scores and unfavorable diet scores. CONCLUSIONS: In this sample of sexual and gender minority adults, the significant differences in the prevalence of unfavorable LE8 component scores between groups highlight the importance of population-specific interventions in future research.