Date of Award

Fall 12-2018

Degree Name

Master of Science (MS)

Advisor(s)

ALANNA C. MORRISON, PHD, FAHA

Second Advisor

STACIA DESANTIS, MS PHD

Abstract

Cardiovascular disease (CVD) is the leading cause of female deaths in the United States (1). While women, in general, are at risk for CVD, current research indicates that sexual minority women (i.e. lesbians and bisexual women [SMW]) may be at greater risk for CVD than heterosexual women. This heightened risk potentially stems from an increased prevalence of traditional CVD risk factors in SMW, creating health disparities between SMW and their heterosexual counterparts (2). Further research into this high-risk population is needed, in order to minimize these disparities.

The purpose of this study was to establish differences in the prevalence of modifiable CVD risk factors among lesbians and heterosexual women and compare their risks for coronary heart disease. This study also sought to identify best practices for obtaining higher rates of sexual orientation (SO) disclosure in questionnaire settings.

Data collected through the Houston HeartReach Registry from 2013-2017 was used for the creation of a lesbian cohort. A cohort of heterosexual women was aggregated from the 2015-2016 National Health and Nutrition Examination Surveys. Both cohorts contained information on sociodemographic data and traditional CVD risk factors. A 10-year risk score for developing coronary heart disease was calculated for all women and compared by SO. Differences in the prevalence of traditional cardiovascular disease risk factors were also examined by SO.

Lesbians were more likely to be current or ever smokers, to be depressed or have hypertension, to have an education level past high school, and to earn less income than their heterosexual counterparts. On average, lesbian participants had a 0.60% (95% confidence interval [CI] = -0.25%, 1.44%) greater chance of developing coronary heart disease over the next ten years than their heterosexual counterparts, but this difference was not significant (p = 0.167). Neither income, glucose, family history of cardiovascular disease, or depression accounted for this difference, but education and body mass index (BMI) partially intensified this difference. Lesbians have an increased prevalence of various CVD risk factors compared to their heterosexual counterparts, but future research is needed to fully understand the causes of these increased risk factors and their effect on CVD risk. With lesbians comprising a uniquely high-risk subgroup for CVD, attention must be paid to their CVD risk profile. The identification of CVD risk factors unique to and/or heightened in lesbians will allow for more targeted interventions that can lead to a reduction in disparities of CVD risk for lesbians and reduce the morbidity of CVD in women overall. A literature review of PubMed, conducted as a part of this thesis, indicates that future epidemiologic studies working with SMW should create an LGBT-welcoming environment, use accepting and inclusive language, and demonstrate a knowledge of lesbian-specific health at recruiting events and in questionnaires, in order to facilitate SO disclosure and increase the likelihood of successful recruitment.

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