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Original Investigation
February 22, 2023

Differences in Ideal Cardiovascular Health Between Sexual Minority and Heterosexual Adults

Author Affiliations
  • 1Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, New York, New York
  • 2Hasso Plattner Institute for Digital Health at Mount Sinai, Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, New York
  • 3Department of Neurology, University of California, San Francisco, San Francisco
  • 4Boston University School of Medicine, Boston, Massachusetts
  • 5Center for Transgender Medicine and Surgery, Mount Sinai, New York, New York
JAMA Cardiol. 2023;8(4):335-346. doi:10.1001/jamacardio.2022.5660
Key Points

Question  Are there differences in cumulative cardiovascular health (CVH) scores between sexual minority and heterosexual adults?

Findings  In this cross-sectional analysis of data from 12 180 participants in the National Health and Nutrition Examination Survey (2007-2016), bisexual female individuals had lower CVH scores compared with heterosexual female individuals, which was primarily attributed to nicotine exposure and higher body mass index. No differences in cumulative CVH were found between other groups of sexual minority adults and their heterosexual peers.

Meaning  Results suggest that there is a need for tailored interventions to improve the CVH of sexual minority individuals, particularly bisexual female individuals.


Importance  Research on the cardiovascular health (CVH) of sexual minority adults has primarily examined differences in the prevalence of individual CVH metrics rather than comprehensive measures, which has limited development of behavioral interventions.

Objective  To investigate sexual identity differences in CVH, measured using the American Heart Association’s revised measure of ideal CVH, among adults in the US.

Design, Setting, and Participants  This cross-sectional study analyzed population-based data from the National Health and Nutrition Examination Survey (NHANES; 2007-2016) in June 2022. Participants included noninstitutional adults aged 18 to 59 years. We excluded individuals who were pregnant at the time of their interview and those with a history of atherosclerotic cardiovascular disease or heart failure.

Exposures  Self-identified sexual identity categorized as heterosexual, gay/lesbian, bisexual, or something else.

Main Outcomes and Measures  The main outcome was ideal CVH (assessed using questionnaire, dietary, and physical examination data). Participants received a score from 0 to 100 for each CVH metric, with higher scores indicating a more favorable CVH profile. An unweighted average was calculated to determine cumulative CVH (range, 0-100), which was recoded as low, moderate, or high. Sex-stratified regression models were performed to examine sexual identity differences in CVH metrics, disease awareness, and medication use.

Results  The sample included 12 180 participants (mean [SD] age, 39.6 [11.7] years; 6147 male individuals [50.5%]). Lesbian (B = −17.21; 95% CI, −31.98 to −2.44) and bisexual (B = −13.76; 95% CI, −20.54 to −6.99) female individuals had less favorable nicotine scores than heterosexual female individuals. Bisexual female individuals had less favorable body mass index scores (B = −7.47; 95% CI, −12.89 to −1.97) and lower cumulative ideal CVH scores (B = −2.59; 95% CI, −4.84 to −0.33) than heterosexual female individuals. Compared with heterosexual male individuals, gay male individuals had less favorable nicotine scores (B = −11.43; 95% CI, −21.87 to −0.99) but more favorable diet (B = 9.65; 95% CI, 2.38-16.92), body mass index (B = 9.75; 95% CI, 1.25-18.25), and glycemic status scores (B = 5.28; 95% CI, 0.59-9.97). Bisexual male individuals were twice as likely as heterosexual male individuals to report a diagnosis of hypertension (adjusted odds ratio [aOR], 1.98; 95% CI, 1.10-3.56) and use of antihypertensive medication (aOR, 2.20; 95% CI, 1.12-4.32). No differences in CVH were found between participants who reported their sexual identity as something else and heterosexual participants.

Conclusion and Relevance  Results of this cross-sectional study suggest that bisexual female individuals had worse cumulative CVH scores than heterosexual female individuals, whereas gay male individuals generally had better CVH than heterosexual male individuals. There is a need for tailored interventions to improve the CVH of sexual minority adults, particularly bisexual female individuals. Future longitudinal research is needed to examine factors that might contribute to CVH disparities among bisexual female individuals.

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