Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study.
Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study.
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DOI：
10.7326/m17-2785
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发表时间：
2018-08-21
影响因子：
39.2
通讯作者：
Goodman M
中科院分区：
文献类型：
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作者：
Getahun D;Nash R;Flanders WD;Baird TC;Becerra-Culqui TA;Cromwell L;Hunkeler E;Lash TL;Millman A;Quinn VP;Robinson B;Roblin D;Silverberg MJ;Safer J;Slovis J;Tangpricha V;Goodman M
变性人的静脉血栓栓塞症(VTE)、缺血性中风和心肌梗死可能与激素的使用有关。检查这些事件在变性人队列中的发生率。基于电子病历的队列研究，对从2006年到2014年有索引日期(变性人身份的第一个证据)的综合医疗保健系统中的变性人成员进行研究。10名男性和10名女性顺性参与者根据出生年份、种族/民族、研究地点和索引日期注册与每个变性人参与者进行匹配。乔治亚州和加利福尼亚州北部和南部的Kaiser Permanente。2842名变性女性和2118名变性男性成员的平均随访期分别为4.0年和3.6年，与48686名顺性别男性和48775名顺性别女性相匹配。在变性人和参考队列中，从诊断代码到2016年底确定的VTE、缺血性中风和心肌梗死事件。跨女性参与者的VTE发生率更高，相对于顺性男性，2年和8年风险差异分别为4.1(95%CI，1.6至6.7)和16.7(CI，6.4至27.5)，与顺性女性相比，分别为3.4(CI，1.1至5.6)和13.7(CI，4.1至22.7)。对缺血性中风和心肌梗死的总体分析显示，不同组之间的发病率相似。在随访期间开始激素治疗的跨女性参与者中，观察到在VTE和缺血性中风方面有更明显的差异。证据不足以得出关于变性人参与者风险的结论。无法确定哪些变性人成员在其他地方接受了激素。在变性女性中，静脉血栓栓塞率和缺血性中风发生率的增加模式与顺性女性中观察到的模式不一致。这些结果可能表明，在确定跨性别雌激素的血管副作用时，需要长期保持警惕。
Venous thromboembolism (VTE), ischemic stroke, and myocardial infarction in transgender persons may be related to hormone use. To examine the incidence of these events in a cohort of transgender persons. Electronic medical record-based cohort study of transgender members of integrated health care systems who had an index date (first evidence of transgender status) from 2006 through 2014. Ten male and 10 female cisgender enrollees were matched to each transgender participant by year of birth, race/ethnicity, study site, and index date enrollment. Kaiser Permanente in Georgia and northern and southern California. 2842 transfeminine and 2118 transmasculine members with a mean follow-up of 4.0 and 3.6 years, respectively, matched to 48 686 cisgender men and 48 775 cisgender women. VTE, ischemic stroke, and myocardial infarction events ascertained from diagnostic codes through the end of 2016 in transgender and reference cohorts. Transfeminine participants had a higher incidence of VTE, with 2-and 8-year risk differences of 4.1 (95% CI, 1.6 to 6.7) and 16.7 (CI, 6.4 to 27.5) per 1000 persons relative to cisgender men and 3.4 (CI, 1.1 to 5.6) and 13.7 (CI, 4.1 to 22.7) relative to cisgender women. The overall analyses for ischemic stroke and myocardial infarction demonstrated similar incidence across groups. More pronounced differences for VTE and ischemic stroke were observed among transfeminine participants who initiated hormone therapy during follow-up. The evidence was insufficient to allow conclusions regarding risk among transmasculine participants. Inability to determine which transgender members received hormones elsewhere. The patterns of increases in VTE and ischemic stroke rates among transfeminine persons are not consistent with those observed in cisgender women. These results may indicate the need for long-term vigilance in identifying vascular side effects of cross-sex estrogen.