Sexual Identity, Adverse Life Experiences, and Cardiovascular Health in Women
Sexual Identity, Adverse Life Experiences, and Cardiovascular Health in Women
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DOI：
10.1097/jcn.0000000000000588
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发表时间：
2019-09-01
影响因子：
2
通讯作者：
Hughes, Tonda L.
中科院分区：
文献类型：
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作者：
Caceres, Billy A.;Markovic, Nina;Hughes, Tonda L.
背景资料：不良生活经历（ALE;例如，歧视和性虐待）可能会导致性少数女性（SMW）的心血管疾病（CVD）风险，但很少有研究测试ALE是否解释了女性性身份与心血管健康（CVH）标志物的关联。目的：本研究的目的是探讨女性CVH的性别认同差异和ALE的作用。研究方法：在女性风险的流行病学研究中，我们使用美国心脏协会的Life's Simple 7指标和总分，使用多项logistic回归评估CVH标志物（理想vs差，中等vs差）的性别认同差异（SMW vs异性恋女性[参考组]）。接下来，我们测试了传统CVD危险因素或ALE是否会减弱性别认同与总CVH评分的关联。结果：样本包括867名女性（395名异性恋，472名SMW）。与异性恋女性相比，性少数女性更有可能经历歧视（P <.001）和终身性虐待（P <.001）。性少数女性也不太可能符合目前烟草使用的理想CVH标准（调整后的比值比，0.43; 95%置信区间，0.24 - 0.73）或体重指数的中间CVH标准（调整后的比值比，0.60; 95%置信区间，0.40 - 0.92）。性少数女性的累积CVH评分（B [SE]=-0.35 [0.14]，P <0.01）低于异性恋女性。这种差异不能用传统的CVD风险因素或ALE来解释。结论：吸烟、体重指数和空腹血糖是性别差异导致CVH差异的主要原因，但ALE不能解释这些差异。应考虑针对SMW的健康行为干预措施。
Background: Adverse life experiences (ALE; eg, discrimination and sexual abuse) may contribute to cardiovascular disease (CVD) risk in sexual minority women (SMW), but few studies have tested whether ALE explain the association of sexual identity with cardiovascular health (CVH) markers in women. Objective: The aim of this study was to examine sexual identity differences in CVH among women and the role of ALE. Methods: In the Epidemiologic Study of Risk in Women, we used multinomial logistic regression to assess sexual identity differences (SMW vs heterosexual women [reference group]) in CVH markers (ideal vs poor, intermediate vs poor) using the American Heart Association's Life's Simple 7 metric and the total score. Next, we tested whether the association of sexual identity with the total CVH score was attenuated by traditional CVD risk factors or ALE. Results: The sample consisted of 867 women (395 heterosexual, 472 SMW). Sexual minority women were more likely to have experienced discrimination (P < .001) and lifetime sexual abuse (P < .001) than heterosexual women. Sexual minority women were also less likely to meet ideal CVH criteria for current tobacco use (adjusted odds ratio, 0.43; 95% confidence interval, 0.24-0.73) or intermediate CVH criteria for body mass index (adjusted odds ratio, 0.60; 95% confidence interval, 0.40-0.92). Sexual minority women had a lower cumulative CVH score (B [SE] = -0.35 [0.14], P < .01) than heterosexual women. This difference was not explained by traditional CVD risk factors or ALE. Conclusions: Smoking, body mass index, and fasting glucose accounted for much of the CVH disparity due to sexual identity, but those differences were not explained by ALE. Health behavior interventions tailored to SMW should be considered.