Toward a Better Understanding of Cardiovascular Risk in the Transgender and Gender-Diverse Community: A Global Call to Action.

On World Heart Day 2022, the Mexican Society of Cardiology, the Inter-American Society of Cardiology, and the World Heart Federation collaborated on a public call to action regarding the increased risk of adverse cardiovascular health outcomes in transgender and gender diverse (TGD) individuals. The aim of this article is to unpack the numerous factors that contribute to this, such as the social stigma faced by members of the TGD community, their reduced access to clinical care, and the scarcity of research regarding the unique needs of their community, which makes it difficult for clinicians to provide individualized medical care. Decreasing the incidence of adverse cardiovascular events among TGD individuals requires interventions such as educational reform in the medical community, an increase in inclusive research studies, and broader social initiatives intended to reduce the stigma faced by TGD individuals.

Cancer and cardiotoxicity in the transgender population.

The relationship between cancer diagnosis and cardiovascular diseases is complex, with newly diagnosed patients facing a higher risk of coronary disease, heart failure, and atrial fibrillation. Compared to the general population, they have two to six times more risk of dying from cardiovascular causes. Cardiovascular complications arising from chemotherapy and radiotherapy, along with social and healthcare access disparities, complicate the collection of accurate data on the incidence of cancer and cardiotoxicity in marginalized populations. Among the LGBTQ community, certain types of cancer are more prevalent, and hormone administration for gender affirmation is also under study. The delay in cancer screening in the transgender population results in late detections and deaths from cancer. Research on cancer in the transgender population and cardiotoxicity is limited, but special attention is needed to develop detection and prevention strategies in specific situations, such as hormone-dependent tumors.

La relación entre el diagnóstico de cáncer y enfermedades cardiovasculares es compleja, con pacientes recién diagnosticados enfrentando un mayor riesgo de enfermedad coronaria, insuficiencia cardíaca y fibrilación auricular. Comparados con la población general, tienen de dos a seis veces más riesgo de morir por causas cardiovasculares. Las complicaciones cardiovasculares derivadas de la quimioterapia y la radioterapia, junto con disparidades sociales y de acceso a la salud, complican la recopilación de datos precisos sobre la incidencia de cáncer y cardiotoxicidad en poblaciones marginadas. Entre la comunidad LGTBQ, ciertos tipos de cáncer son más frecuentes, y la administración de hormonas para la reafirmación de género también está bajo estudio. El retraso en el cribado de cáncer en la población transgénero resulta en detecciones tardías y muertes por cáncer. La investigación sobre cáncer en la población transgénero y cardiotoxicidad es limitada, pero se requiere atención especial para desarrollar estrategias de detección y prevención en situaciones específicas, como tumores dependientes de hormonas.

Toward a better understanding of cardiovascular risk in the transgender and gender-diverse community: a supplement to the Tijuana Declaration.

On World Heart Day 2022, the Mexican Society of Cardiology, the Inter-American Society of Cardiology, and the World Heart Federation collaborated on a communication regarding the increased risk of adverse cardiovascular health outcomes in transgender and gender-diverse (TGD) individuals. This document, called the Tijuana Declaration, urged the global cardiovascular community to work toward understanding and mitigating this problem. This article aims to unpack the numerous factors that lead to it. An example is the social stigma faced by members of the TGD community, which leads to increased stress and risk for cardiovascular complications. TGD patients are also more likely to have insufficient access to health care, and those that do receive care are often faced with providers that are not adequately educated about the unique needs of their community. Finally, there is some evidence to suggest that gender-affirming hormone therapies have an impact on cardiovascular health, but studies on this subject often have methodological concerns and contradictory findings. Decreasing the incidence of adverse cardiovascular events in this community requires interventions such as educational reform in the medical community, an increase in research studies on this topic, and broader social initiatives intended to reduce the stigma faced by TGD individuals.

En el Día Mundial del Corazón 2022, la Sociedad Mexicana de Cardiología, la Sociedad Interamericana de Cardiología y la Federación Mundial del Corazón colaboraron en una comunicación sobre el aumento del riesgo de resultados adversos para la salud cardiovascular en individuos transgénero y de género diverso (TGD). Este documento, conocido como la Declaración de Tijuana, instó a la comunidad cardiovascular global a trabajar en la comprensión y mitigación de este problema. Este artículo tiene como objetivo desentrañar los numerosos factores que lo provocan. Un ejemplo es el estigma social enfrentado por los miembros de la comunidad TGD, lo que conduce a un aumento del estrés y el riesgo de complicaciones cardiovasculares. Los pacientes TGD también tienen más probabilidades de tener un acceso insuficiente a la atención médica, y aquellos que la reciben a menudo se enfrentan a proveedores que no están adecuadamente educados sobre las necesidades únicas de su comunidad. Finalmente, hay evidencia que sugiere que las terapias hormonales de afirmación de género tienen un impacto en la salud cardiovascular, pero los estudios sobre este tema a menudo tienen preocupaciones metodológicas y hallazgos contradictorios. Disminuir la incidencia de eventos cardiovasculares adversos en esta comunidad requiere intervenciones como la reforma educativa en la comunidad médica, un aumento en los estudios de investigación sobre este tema e iniciativas sociales más amplias destinadas a reducir el estigma enfrentado por los individuos TGD.

Toward a better understanding of cardiovascular risk in the transgender and gender-diverse community: a supplement to the Tijuana Declaration / El camino hacia una mejor comprensión del riesgo cardiovascular en la comunidad transgénero y diferentes géneros: un suplemento a la Declaración de Tijuana

Abstract On World Heart Day 2022, the Mexican Society of Cardiology, the Inter-American Society of Cardiology, and the World Heart Federation collaborated on a communication regarding the increased risk of adverse cardiovascular health outcomes in transgender and gender-diverse (TGD) individuals. This document, called the Tijuana Declaration, urged the global cardiovascular community to work toward understanding and mitigating this problem. This article aims to unpack the numerous factors that lead to it. An example is the social stigma faced by members of the TGD community, which leads to increased stress and risk for cardiovascular complications. TGD patients are also more likely to have insufficient access to health care, and those that do receive care are often faced with providers that are not adequately educated about the unique needs of their community. Finally, there is some evidence to suggest that gender-affirming hormone therapies have an impact on cardiovascular health, but studies on this subject often have methodological concerns and contradictory findings. Decreasing the incidence of adverse cardiovascular events in this community requires interventions such as educational reform in the medical community, an increase in research studies on this topic, and broader social initiatives intended to reduce the stigma faced by TGD individuals.

Resumen En el Día Mundial del Corazón 2022, la Sociedad Mexicana de Cardiología, la Sociedad Interamericana de Cardiología y la Federación Mundial del Corazón colaboraron en una comunicación sobre el aumento del riesgo de resultados adversos para la salud cardiovascular en individuos transgénero y de género diverso (TGD). Este documento, conocido como la Declaración de Tijuana, instó a la comunidad cardiovascular global a trabajar en la comprensión y mitigación de este problema. Este artículo tiene como objetivo desentrañar los numerosos factores que lo provocan. Un ejemplo es el estigma social enfrentado por los miembros de la comunidad TGD, lo que conduce a un aumento del estrés y el riesgo de complicaciones cardiovasculares. Los pacientes TGD también tienen más probabilidades de tener un acceso insuficiente a la atención médica, y aquellos que la reciben a menudo se enfrentan a proveedores que no están adecuadamente educados sobre las necesidades únicas de su comunidad. Finalmente, hay evidencia que sugiere que las terapias hormonales de afirmación de género tienen un impacto en la salud cardiovascular, pero los estudios sobre este tema a menudo tienen preocupaciones metodológicas y hallazgos contradictorios. Disminuir la incidencia de eventos cardiovasculares adversos en esta comunidad requiere intervenciones como la reforma educativa en la comunidad médica, un aumento en los estudios de investigación sobre este tema e iniciativas sociales más amplias destinadas a reducir el estigma enfrentado por los individuos TGD.

Cáncer y cardiotoxicidad en la población transgénero / Cancer and cardiotoxicity in the transgender population

Resumen La relación entre el diagnóstico de cáncer y enfermedades cardiovasculares es compleja, con pacientes recién diagnosticados enfrentando un mayor riesgo de enfermedad coronaria, insuficiencia cardíaca y fibrilación auricular. Comparados con la población general, tienen de dos a seis veces más riesgo de morir por causas cardiovasculares. Las complicaciones cardiovasculares derivadas de la quimioterapia y la radioterapia, junto con disparidades sociales y de acceso a la salud, complican la recopilación de datos precisos sobre la incidencia de cáncer y cardiotoxicidad en poblaciones marginadas. Entre la comunidad LGTBQ, ciertos tipos de cáncer son más frecuentes, y la administración de hormonas para la reafirmación de género también está bajo estudio. El retraso en el cribado de cáncer en la población transgénero resulta en detecciones tardías y muertes por cáncer. La investigación sobre cáncer en la población transgénero y cardiotoxicidad es limitada, pero se requiere atención especial para desarrollar estrategias de detección y prevención en situaciones específicas, como tumores dependientes de hormonas.

Abstract The relationship between cancer diagnosis and cardiovascular diseases is complex, with newly diagnosed patients facing a higher risk of coronary disease, heart failure, and atrial fibrillation. Compared to the general population, they have two to six times more risk of dying from cardiovascular causes. Cardiovascular complications arising from chemotherapy and radiotherapy, along with social and healthcare access disparities, complicate the collection of accurate data on the incidence of cancer and cardiotoxicity in marginalized populations. Among the LGBTQ community, certain types of cancer are more prevalent, and hormone administration for gender affirmation is also under study. The delay in cancer screening in the transgender population results in late detections and deaths from cancer. Research on cancer in the transgender population and cardiotoxicity is limited, but special attention is needed to develop detection and prevention strategies in specific situations, such as hormone-dependent tumors.

End-of-life care in a cardiology department: have we improved?

BACKGROUND: End-of-life care is not usually a priority in cardiology departments. We sought to evaluate the changes in end-of-life care after the introduction of a do-not-resuscitate (DNR) order protocol. METHODS & RESULTS: Retrospective analysis of all deaths in a cardiology department in two periods, before and after the introduction of the protocol. Comparison of demographic characteristics, use of DNR orders, and end-of-life care issues between both periods, according to the presence in the second period of the new DNR sheet (Group A), a conventional DNR order (Group B) or the absence of any DNR order (Group C). The number of deaths was similar in both periods (n = 198 vs. n = 197). The rate of patients dying with a DNR order increased significantly (57.1% vs. 68.5%; P = 0.02). Only 4% of patients in both periods were aware of the decision taken about cardiopulmonary resuscitation. Patients in Group A received the DNR order one day earlier, and 24.5% received it within the first 24 h of admission (vs. 2.6% in the first period; P < 0.001). All patients in Group A with an implantable cardioverter defibrillator (ICD) had shock therapies deactivated (vs. 25.0% in the first period; P = 0.02). CONCLUSIONS: The introduction of a DNR order protocol may improve end-of-life care in cardiac patients by increasing the use and shortening the time of registration of DNR orders. It may also contribute to increase ICD deactivation in patients with these orders in place. However, the introduction of the sheet in late stages of the disease failed to improve patient participation.

Oral anticoagulation in octogenarians with atrial fibrillation.

BACKGROUND: Vitamin K antagonists (VKAs) are still largely employed, even in nonvalvular atrial fibrillation (AF). Our aim was to study the clinical profile of octogenarians treated with oral anticoagulation and to study the effect of age on the quality of VKAs anticoagulation. METHODS: Data are from a prospective national registry in an adult Spanish population of nonvalvular AF. We included 1637 patients who had been receiving VKAs for at least 6months before enrolment. RESULTS: Mean age was 73.8±9.4years. Patients aged >80years (N=429) had a high risk profile with higher risk of stroke and bleeding than younger patients; CHA2DS2-VASc (Cardiac failure, Hypertension, Age>74, Diabetes, Stroke, Vascular disease, Age 65-74years, and Sex category) 4.5±1.3 vs. 3.5±1.6, p<0.001, HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (>64years), Drugs/alcohol concomitantly) 2.4±0.9 vs. 1.9±1.1, p<0.001. Creatinine clearance was lower in octogenarians than in younger patients (54.3±16.1ml/min vs. 69.5±23.7ml/min, p<0.001) and severe renal disease with creatinine clearance <30ml/min was more frequent in octogenarians (5.2% vs. 2.2%, p<0.001). In patients treated with VKAs (N=1637), the international normalized ratio values of the 6months previous to enrollment were similar in all age quartiles, as was the time in the therapeutic range. CONCLUSION: In this large registry octogenarians with nonvalvular AF had high risk of stroke and bleeding and frequent renal disease. VKAs anticoagulation quality was similar in octogenarians and in younger patients.