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Heart Health Scores Lower in Sexual Minority Women

A model of a heart.
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A study examining ideal cardiovascular health scores in sexual minority (SM) populations found that lesbian and bisexual women have lower scores compared to heterosexual women. The research, published in the Journal of the American Heart Association, was conducted in France.

Health disparities in sexual minorities

A growing body of research demonstrates that SM groups are disproportionately affected by poor health outcomes, an issue that was formally recognized by the National Institute on Minority Health and Health Disparities in 2016.

A new study is the first to evaluate cardiovascular health disparities – using the American Heart Association’s (AHA) Life’s Essential 8 (LE8) and Life’s Simple 7 (LS7)metrics for ideal cardiovascular health – among individuals that self-report as lesbian, gay, bisexual or heterosexual.

Life’s Essential 8

Are the “key measures for improving and maintaining cardiovascular health” as defined by the AHA. In 2022, LE8 was updated to add healthy sleep as a cardiovascular health factor, in addition to the existing 7 factors:

  • Regular physical activity
  • A healthy diet
  • A healthy weight
  • No smoking
  • Normal blood sugar levels
  • Normal cholesterol levels
  • Normal blood pressure levels

The AHA’s Life’s Essential 8™ image is a wheel shape with 8 wedges representing the 8 elements that are essential for cardiovascular health. Credit: American Heart Association 2022.

“Improving cultural competency and awareness of cardiovascular disease risk among SM adults may help to improve conversations between doctors and patients about cardiovascular health, including prevention and management,” says Omar Deraz, lead author and a graduate student affiliated with Université Paris Cité, Inserm (French National Institute of Health and Medical Research) and the Paris Cardiovascular Research Center’s Integrative Epidemiology of Cardiovascular Disease Team. “Understanding and overcoming barriers to health care access are essential to improve cardiovascular disease prevention and care in sexual minorities.”

The research team analyzed health data on almost 170,000 adults without cardiovascular disease in France. The average age of participants was 46 years, and approximately 54% were women. Using self-report measures, 93% of women in the study identified as heterosexual, 3.5% as bisexual and less than 1% as lesbian. Of the 78,550 men included, 90% identified as heterosexual, 3.5% identified as bisexual and 3% identified as gay.

All individuals included in the present study had previously participated in a nationwide research project called CONSTANCES (CONSulTANts des Centres d’Examens de Santé), which explored risk factors for chronic diseases and aging between 2012–2020. Throughout the duration of the study, participants attended health centers across France for clinical examinations and laboratory tests at baseline and then every four years. Using this data, the researchers computed LE8 and LS7 scores according to the AHA guidelines.

Lower cardiovascular health scores in sexual minority women

The research team adjusted the data for age, social factors and a family history of cardiovascular disease. The results show that lesbian and bisexual women in this study had lower LE8 cardiovascular health scores compared to heterosexual women.  

How is the LE8 score calculated?

The LE8 score includes physical activity, diet, smoking, BMI, sleep health, blood pressure, blood lipids and blood glucose metrics. The score for each metric is between 0 to 100, with a higher score indicating greater cardiovascular health.

For example, the physical activity score was computed based on the equivalent of weekly minutes of moderate or high intensity off-work sports activity. Individuals spending 1–29 minutes per week scored 20, while individuals spending 120–149 minutes per week scored 90. The LE8 was the average of all metric scores, ranging from low (0–49), moderate (50–79) to high (80–100). Nicotine exposure, in contrast, was scored at 100 if participants had never smoked, decreasing to 0 for current smokers. The LS7 score used the same metrics as the LE8 score, excluding the sleep health metric.

“The lower cardiovascular health scores in SM women compared with their heterosexual counterparts in the current study are consistent with the increased cardiovascular disease risk observed in SM women in the NHANES and Add Health studies,” the researchers write in the paper. Women identifying as lesbian also had lower scores for healthy diet and healthy blood pressure levels, while bisexual women had higher scores for healthy diet and nicotine exposure.

Gay and bisexual men’s cardiovascular health scores were higher compared to heterosexual men. “This may suggest that: (1) levels of exposure to stressors, such as discrimination, might differ between SM men and SM women compared with heterosexual individuals; and (2) differences in the available coping resources and resilience to buffer against minority stressors might exist in SM women and SM men,” the authors write in the discussion of the paper.

Consistent findings were found when determining the LS7 score, however these were of “smaller magnitudes” the researchers say.

Research into a grossly underrepresented population

The authors stress that while the findings of this study cannot be generalized to other countries – France is a high-income region with universal healthcare insurance – it is nevertheless essential data to collect. “It’s important research into a population that is grossly underrepresented in clinical and epidemiological studies,” says Dr. Connie Tsao, assistant professor of medicine at Harvard Medical School and a volunteer chair at the AHA’s 2023 Statistical Update writing group. She adds that to address discrimination and disparities that can impact health, we must better understand the “unique experiences of all individuals and populations”, including sexual minorities.

Deraz and other members of the research team implore future research to include social demographics, including sexual orientation, gender identity and sex. They note that, in this study, it was not possible to include data on cardiovascular health for individuals identifying as transgender, as “no data was available at the time of the study.” 

Reference: Deraz O, Caceres B, Streed C, et al. Sexual minority status disparities in Life’s Essential 8 and Life’s Simple 7 cardiovascular health scores: A French nationwide population-based study. JAHA. 2023. doi: 10.1161/JAHA.122.028429

This article is a rework of a press release issued by the American Heart Association. Material has been edited for length and content.

Meet the Author
Molly Campbell
Molly Campbell
Senior Science Writer