Understanding cardiovascular disease among transgender people: the journey continues.
Understanding cardiovascular disease among transgender people: the journey continues.
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了解跨性别者的心血管疾病：旅程仍在继续。
DOI：
10.1093/eurjpc/zwac182
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发表时间：
2022
影响因子：
8.3
通讯作者：
Goodman,Michael
中科院分区：
文献类型：
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作者：
Goodman,Michael
随着越来越多的高质量研究的出现，跨性别健康研究正在经历快速转变。然而，跨性别健康的许多领域的科学现状仍然具有相当大的不确定性。一个不确定的领域是女性化性别确认激素治疗（GAHT）的潜在血栓效应。3-5如其他文献所述，含有雌激素的GAHT会提高循环中各种促凝剂的水平，如血管性血液病因子、纤维蛋白原、因子II、VII、VIII和X，并增加血清c4b结合蛋白的浓度，从而使天然抗凝蛋白s失活6,7尽管有这些考虑，但GAHT相关的血栓事件风险，如静脉血栓栓塞、缺血性中风和心肌梗死，尚未得到充分的表征。理论上，解决这一问题的最有力证据可以从随机临床试验中获得；然而，在实践中，这样的试验既不可行，也不符合伦理。在缺乏临床试验证据的情况下，最好的选择是从高质量的观察性队列研究中获取数据。在这一期的《欧洲预防心脏病学杂志》上，Karalexi等人发表了他们对瑞典国家卫生保健登记处的一项队列研究数据的分析。该研究的目的是比较跨性别者（基于性别焦虑症诊断）的心血管事件发生率与匹配的男性和女性顺性别参照者的相应发生率。对跨女性（出生时被指定为男性）和跨男性（出生时被指定为女性）个体分别进行分析。每个分析使用三种方法重复：首先通过比较接受GAHT的跨性别队列与每个相应的顺性别参考组，然后进行相同的比较，但将跨性别参与者限制在没有GAHT证据的人群中，最后通过比较GAHT和非GAHT的跨性别队列。研究人员报告说，跨性别研究参与者的急性心血管事件发生率较低，尽管高于顺性别参照物的相应发生率。也许更重要的是，他们观察到，与没有接受过GAHT证据的跨性别参与者相比，接受GAHT治疗的跨性别参与者的发病率差异并不明显。
Transgender health research is undergoing rapid transformation with higher quality studies becoming increasingly available. Yet, the state-of the science in many areas of transgender health is still characterized by considerable uncertainty. 1, 2 One area of uncertainty is the potential thrombotic effect of feminizing gender-affirming hormone therapy (GAHT). 3–5 As reviewed elsewhere, oestrogencontaining GAHT produces elevated circulating levels of various procoagulants such as von Willebrand factor, fibrinogen, factors II, VII, VIII and X and increases serum concentration of C4b-binding protein, which in turn deactivates a natural anticoagulant Protein S. 6, 7 Despite these considerations, the GAHT-related risk of thrombotic events, such as venous thromboembolism, ischaemic stroke, and myocardial infarction, has not been fully characterized. In theory, the strongest evidence addressing this issue could be obtained from randomized clinical trials; however, in practice, such trials are neither feasible nor ethically acceptable. 8 In the absence of evidence from clinical trials, the best remaining option is to obtain data from high-quality observational cohort studies. In this issue of the European Journal of Preventive Cardiology, Karalexi et al. presented their analyses of the data from a cohort study nested within the Swedish national health care registries. The goal of the study was to compare rates of cardiovascular events in transgender persons (identified based on gender dysphoria diagnoses) with the corresponding rates observed among matched male and female cisgender referents. The analysis was performed separately for transfeminine (assigned male at birth) and transmasculine (assigned female at birth) individuals. Each analysis was repeated using three approaches: first by comparing the transgender cohorts receiving GAHT to each of the respective cisgender reference groups, next by performing the same comparison, but limiting the transgender participants to those without evidence of GAHT, and lastly by comparing GAHT and non-GAHT transgender cohorts to each other.The investigators reported that the rates of acute cardiovascular events among transgender study participants were low, albeit higher than the corresponding rates among cisgender referents. Perhaps more importantly, they observed that the differences in incidence were no more pronounced for transfeminine participants on GAHT than for transfeminine participants without evidence of GAHT receipt.