Are Sexual Minorities at an Increased Risk for Cardiovascular Disease?

Among noncommunicable diseases, cardiovascular disease (CVD) is the leading cause of death worldwide, accounting for 17.9 million deaths in 2016.1 In the United States the incidence of CVD deaths declined steadily from 1970 to 2014 but halted at 800,000 deaths a year in 2014 and since then has been trending upward.2 Due to an aging population and a dramatic rise in obesity over the past 25 years, the prevalence of CVD in the US is expected to increase by 10% between 2010 and 2030.3 Cardiovascular disease is a broad term that includes coronary heart disease, cerebrovascular disease, and peripheral vascular disease—3 anatomically distinct diseases that are unified by the pathogenesis of atherosclerosis. It is estimated that by year 2035, 45.1% of Americans (\u3e130 million adults) will be diagnosed with some form of CVD.2 This projection translates into an estimated 1.1 trillion dollars that the US healthcare system will pay for both the direct and indirect costs associated with CVD.2 This increasing prevalence and rising burden of CVD has led many researchers to focus on primary prevention of the disease. One way to bolster primary prevention of CVD is to identify patient populations that may be at an increased risk of developing this disease. As outlined in a 2011 report from the Institute of Medicine, sexual minorities experience a number of health disparities that are linked to worse health outcomes.4 The minority stress model is commonly used to frame discussions surrounding these health disparities, whereby sexual and gender minorities experience chronic stress as a consequence of their stigmatization as a minority group.4 Chronic psychological stress has been linked to chronic disease such as CVD and can also lead to behaviors such as tobacco and alcohol use, poor dietary choices, and decreased physical activity, all of which impact an individual’s cardiovascular risk. Thus, sexual minorities (lesbian, gay, and bisexual) may have an even greater risk of developing CVD when compared to their heterosexual counterparts. If CVD risk is indeed increased for sexual minorities, clinicians will need to implement earlier and more aggressive preventive measures for this population in order to achieve health equity