Lesbian and bisexual women may be less likely to have ideal heart health scores than heterosexual women, according to new research. Gay or bisexual men, however, scored higher than their heterosexual peers, but only if they lived in urban areas.
The study, published Wednesday in the Journal of the American Heart Association, measured cardiovascular health among lesbian, gay, bisexual and heterosexual adults in France using the American Heart Association's Life's Essential 8, a set of lifestyle behaviors and factors for good cardiovascular health.
The metrics encourage people to be physically active, eat a healthy diet, sleep seven to nine hours each night, manage their weight, avoid tobacco products, and to control blood pressure, blood glucose and cholesterol levels.
"Improving these metrics is a great opportunity to prevent heart problems before they happen," Omar Deraz, the study's lead author, said in a news release. Deraz is a researcher with Inserm, the French National Institute of Health and Medical Research, and the Paris Cardiovascular Research Center's Integrative Epidemiology of Cardiovascular Disease Team.
The study is the first to measure cardiovascular health disparities using Life's Essential 8 among gay, lesbian and bisexual people, researchers said.
The study included health data from about 169,400 adults in France – including nearly 91,000 women – who participated in the nationwide Constances study. Participants did not have cardiovascular disease and had an average age of 46.
Among the women, 93% identified as heterosexual; about 3.5% identified as bisexual; and 0.61% identified as lesbian. Among the men, 90% identified as heterosexual; 3.5% identified as bisexual; and 3% identified as gay. About 3% of all participants declined to answer questions about their sexual orientation.
After adjusting for variables such as family history of cardiovascular disease, age and social factors, the researchers found that lesbian and bisexual women had lower cardiovascular health scores compared to heterosexual women. Gay and bisexual men living in urban areas scored higher than heterosexual men, whereas those living in rural areas had lower cardiovascular health scores and were less likely to reach ideal cardiovascular health.
Compared to their heterosexual peers, lesbian women scored lower for healthy diet and blood pressure. In contrast, bisexual women had higher scores for healthy diet and nicotine exposure.
Previous research shows LGBT adults are less likely to access health care and more likely to delay treatment than heterosexual adults. Deraz said it is essential to recognize and overcome barriers to health care access.
"Improving cultural competency and awareness of cardiovascular disease risk among sexual minority adults may help to improve conversations between doctors and patients about cardiovascular health," he said.
The study's authors said, citing previous evidence, that LGBT populations disproportionately experience depression and attempted suicide. These have been linked to higher risk of cardiovascular disease. Discrimination and violence fueled by bias, and increased societal stressors, also may lead to unhealthy coping behaviors, including increased alcohol use, smoking and a sedentary lifestyle.
In the study, lesbian, gay and bisexual adults overall reported anxiety disorders, depression symptoms or attempted suicide more frequently than heterosexual adults. However, lesbian women less frequently reported anxiety disorders and depression symptoms compared to heterosexual women.
In a 2020 scientific statement, the AHA noted that LGBTQ adults experience significant psychosocial stressors that compromise their cardiovascular health.
Because France is a high-income country that offers universal health care insurance, the researchers cautioned that their findings may not apply to other countries. The study, they said, also is limited by its single focus on assessing cardiovascular health by sexual orientation, and that heart health data was unavailable for those who identified as transgender.
Even so, "it's important research into a population that is grossly underrepresented in clinical and epidemiological studies," said Dr. Connie Tsao, attending staff cardiologist at Beth Israel Deaconess Medical Center in Boston, who was not involved in the new study.
"To fully address discrimination and disparities that impact health, we must better recognize and understand the unique experiences of all individuals and populations, including sexual minorities," she said.