Transgender persons receiving gender-affirming hormone therapy: risk of acute cardiovascular events in a Dutch cohort study.

Abstract (English)

BACKGROUND AND AIMS: Despite favourable effects of oestradiol on cardiovascular risk factors, previous studies found higher risks of cardiovascular events in transgender women using gender-affirming hormone therapy. However, these studies did not adjust for socioeconomic status and lifestyle. This study investigated the association between gender-affirming hormone therapy and cardiovascular event risk in a large cohort of transgender persons compared with the general population, accounting for these factors. METHODS: This retrospective cohort study included transgender women and transgender men using gender-affirming hormone therapy between 1972 and 2018 at the Amsterdam gender clinic. Medical diagnoses were registered from 2012 to 2022 by a national data registry. Standardized incidence ratios for myocardial infarction, ischaemic cerebrovascular accident, and venous thromboembolism were computed using general population incidence rates adjusted for socioeconomic status, estimated by education, employment, and income. Lifestyle (body mass index, smoking, and alcohol consumption) was analysed by age group. RESULTS: Adjusted for socioeconomic status, transgender women (N = 2714, 23 907 person-years) had lower myocardial infarction risk (.50 [.32; .71]), similar cerebrovascular accident risk (.94 [.72; 1.19]), and higher venous thromboembolism risk (1.81 [1.33; 2.35]) compared with general population men. Transgender men (N = 1617, 13 457 person-years) had higher myocardial infarction risk (4.20 [2.72; 6.01]), higher cerebrovascular accident risk (1.55 [1.01; 2.20]), and similar venous thromboembolism risk (1.00 [.53; 1.61]) compared with general population women. Socioeconomic status minimally impacted these results. Lifestyle largely resembled the general population. CONCLUSIONS: Gender-affirming hormone therapy is not associated with increased cardiovascular risk in transgender women but is in transgender men. This aligns with known effects of oestradiol and testosterone on cardiovascular risk factors.