Cardiovascular Health in Sexual and Gender Minority Populations

Take two minutes to let us know what you think of the Heart to Heart Nurses Podcast. Share your thoughts by March 26, 2026 to be entered into a drawing for a $25 gift card. Visit PCNA.net/podcast Welcome to Heart to Heart Nurses. Brought to you by the Preventive Cardiovascular Nurses Association. PCNA's mission is to promote nurses as leaders in Cardiovascular Disease Prevention and Management. We are so honored today to have Dr. Billy Caceras with us today talking about LGBTQ+ populations and the intersection of cardiovascular disease and the needs that these populations might have. Dr. Caceras, would you be interested in sharing a little bit about yourself with our audience? Sure, thank you for having me today. So I'm a assistant professor at Columbia University at the School of Nursing in the Center for Sexual and Gender Minority Health Research and I study cardiovascular disease disparities in sexual and gender minority adults which is just another name or term that's used to identify lesbian, gay, bisexual, transgender queer people or LGBTQ people. Well we are so grateful to you for spending time with us today and I'm hoping that you can get started by talking a little bit about the factors that contribute to the increased risk of cardiovascular disease among sexual and gender minority populations. Sure, so there are a number of factors that are thought to contribute to cardiovascular, health disparities in sexual and gender minority populations. A lot of them have not been tested in research studies but what we know from other populations we can sort of surmise or guess that they probably exert a similar influence on the cardiovascular health of sexual and gender minority individuals. So sort of the prevailing theory or explanation for cardiovascular health disparities in sexual and gender minority populations is that they experience what we call greater minority stressors and minority stressors are sort of these unique experiences that somebody experiences because of their minority sexual orientation or gender identity. So for instance somebody who identifies as transgender has to deal with the unique stressor or experience of having to actually come out to their family as transgender which is not really an experience that somebody in the general population would have to go through. So the idea is that these minority stressors which can include things like being afraid of being rejected, experiences of discrimination, that these stressors are on top of all the other stressors that we experience as human beings living in society. Things like work stress, family stress that these stressors are more compounded in sexual and gender minority people. So in addition to that there is more and more evidence showing that sexual and gender minority populations particularly by sexual and transgender men and women are much more likely to live in poverty than people who are non sexual and sexual and gender minorities. And even within LGBTQ people we see that people of color, black, Latino, American Indian are about two times more likely to live in poverty than even white sexual and gender minority individuals. So poverty is another sort of factor that we think in Tribute to these disparities and that sort of related to the next factor which is lower access and use of healthcare services. So there's a lot of evidence to show that bisexual women and transgender individuals are much more likely to delay seeking needed healthcare services and that's often due to cost concerns. They're afraid that they can't pay for it but it also is due to other things like they can't take off of work to go to the to go see a provider or they didn't have proper transportation to be able to make it to a certain provider if it's out of the way. And then related to sort of healthcare utilization is the fact that there is research to show that about 70% of transgender people have been discriminated against by a healthcare provider about 50% of lesbian and gay and bisexual people report being discriminated against by a healthcare provider. So we it's easy to see why LGBTQ people might delay seeking care or might avoid seeking care until they really need to in an emergency. But what that does is that it has implications for the identification and management of chronic conditions like hypertension and diabetes which influence heart disease risk. So those are sort of the main factors some additional factors that have been shown to influence cardiovascular health in the general population are things like exposure to violence like exposure to sexual and physical abuse has been shown to increase risk for heart disease, hypertension, diabetes, obesity in the general population. And what we see in sexual and gender minority adult is that they are much more likely to report experiencing things like sexual and physical abuse both in adulthood and in childhood compared to non-sexual and gender minority individuals. So all together these sort of create these circumstances where LGBTQ people just have different experiences that may place them at greater risk for heart disease. Yeah and there's the one thing that I'll say is that there's very little research that's actually tried to link these sort of social determinants that I discuss minority stress, poverty, healthcare utilization with cardiovascular health in sexual and gender minority adults. But some of the work that we've done at Columbia has really shown that things like childhood physical and sexual abuse and adulthood physical and sexual abuse are associated with higher rates of obesity and hypertension among lesbian and bisexual women. There's some other research that indicates that discrimination is associated with higher prevalence of tobacco use among certain sexual and gender minority individuals. So there is sort of this small but growing body of research that's now really trying to link the things that we think influence the cardiovascular health with actual cardiovascular health outcomes. It's sort of a really exciting time to be during this type of work. We are talking today with Dr. Billy Casseris about cardiovascular disease among sexual and gender minority populations. We're going to take a brief break and be right back. Until recently when a patient was diagnosed with HCM, symptom management was the only therapy available. Now with two approved treatments, Mavacampton and Apha Campton, shared decision-making is more important than ever to ensure that patients, family members and caregivers understand available treatment options. Join us April 9th through 11th in Scottsdale, Arizona for PCNA's cardiovascular nursing symposia. Join colleagues from across the country and even the globe to learn from subject matter experts, share best practices and network. If you can't attend a person, join us virtually from your workplace or home. Find more details at PCNA.net/symposium. We're back with Dr. Billy Casseris speaking about cardiovascular health and the special issues that relate to individuals who are sexual and gender minority populations. And Dr. Casseris, if we could segue for our audience into what nurses can do in terms of strategies that they might utilize to promote cardiovascular health in these populations. It's an excellent question. So when I think of the role of nurses, I always think of it as sort of multifactorial and quite complex. So I think as nurses, we generally are thought of in terms of clinical practice, but I think we also have a role in promoting nursing education. We have a role in policy. We have a role in promoting research. So when I think of strategies, I often think of them in those four categories, education, clinical practice, policy and research. So I think there's some strategies for each of those. I'm going to highlight a few of them today. So in terms of clinical practice, there are certain things that practicing cardiovascular nurses can do to sort of promote the cardiovascular health and the well-being of sexual and gender minority individuals. Some of it includes accessing different educational resources to learn more about the needs of the population, sort of what are the pressing health issues in the population. Also, some training around the proper way of assessing someone's sexual orientation or gender identity in clinical practice. So in the year, I think it was 2015, the Obama administration passed a law that made it so that all electronic health record systems must have the capability of assessing sexual orientation and gender identity. So for any nurse that's practicing, most nurses now are probably have access to or are expected to assess sexual orientation and gender identity in certain clinical encounters. But what I think the big issue is that we often don't provide nurses with the proper training to be able to do that. And I think that's a really big gap. And a nurse practicing nurses really can do a lot to sort of move their institutions to ensure that they receive the proper training that they need to actually care for sexual and gender minority individuals. And one aspect of that is how do you assess for sexual orientation and gender identity. But another aspect of that is also understanding for gender individuals, like how do you ask somebody what their preferred pronouns are? How do you refer to someone? What are all these different gender identity terms? What does gender non-binary mean? What does gender non-conforming mean? What does a gender mean? So really, sort of like basic training on the pressing health issues, some terminology, would be really helpful for clinical nurses that are practicing currently? I think that the same could be said for nurses that were now training in bachelor's and associates programs throughout the country that they really, what we've seen in the literature is that nursing programs really dedicate at most maybe five hours to sexual and gender minority health consciousness. content during the scope of an undergraduate program and really that content is to focus on HIV and sexual health without really thinking about all the other health issues that are important for this population. Like cardiovascular disease but also things like depression, anxiety, suicidal ideation and it's really important that we sort of infuse more sexual and general minority health content in nursing curricula. So that the students that we're graduating have sort of a leg up and they sort of have a better understanding of how do you actually care for these populations in a manner that is affirming, that isn't otherwise them and that really sort of meets patients where they're at. Which I think is really important. And then in terms of research there's really so many different research gaps that one of them that I discuss was this idea of well we think these social factors are also determinants, influence the cardiovascular health of sexual and general minority people but we don't really know if they actually do or we haven't comprehensively tested that so I think there's really big opportunities in research to actually try to better understand like well how does somebody's exposure to discrimination contribute to their hypertension risk right? That's sort of this unanswered question that still exists. I think another big thing that's super important is we have no evidence-based interventions for cardiovascular risk reduction that are tailored to sexual and general minority people. We have some for other minority groups like Black and Latinx people but we really don't have anything sort of similar that's been robustly tested for cardiovascular risk reduction in sexual and general minority adults so I think that's a really important area for research sort of thinking about what are the things that need to be addressed in an intervention to improve the cardiovascular health of sexual and general minority adults. And then last I think the big thing is policy and oftentimes when I talk about policy this happens when I talk about policy to graduate students what I often hear is well I don't like being involved in policy because it's too political and there's this sense that if you have an opinion about a policy that it's political but it is political right? If you have an opinion about certain health services that should be universal or access to a particular type of care that a certain population needs that's all regulated by policy so in essence you have to have a political opinion because of that and I think that oftentimes we shy away as nurses from actually having a political opinion but I think when I always think of it as when we're advocating for policies it's always about what is the research evidence show us? What is the research evidence show that's effective and that will work for different populations? And I think the same is true for cardiovascular health. I think we as nurses play a big role we have so many where the largest health care profession we have so many nursing organizations that do a lot of advocacy and policy work and lobbying that we really need to sort of harness that power to really bring about change for the communities that we care about but I think oftentimes what happens with sexual and gender minority populations is that the focus is on policies that are specific to the population so for instance same-sex marriage became legalized at the federal level in 2015 and a lot of people thought well this is going to fix all of the LGBTQ just health disparities that we see but that's really one component of their social sort of their social life right? That we still have policies in which LGBTQ people can be discriminated against in restaurants or police stations like what we call public accommodations and the bigger thing really is thinking about access to health care and income equality we know that LGBTQ people are more likely to not access the needed health services like I said before and they're more likely to live in poverty so really any policies that are enacted in society to sort of bridge the gap in income inequalities and increased care or access to care for people even if it's not a specific policy for LGBTQ people it is going to have a disproportionately beneficial effect on LGBTQ people and other marginalized populations that experience health disparities so I think it's really important that we think sort of beyond the LGBTQ specific things which are important I'm not saying we shouldn't advocate for LGBTQ inclusive policies but I think that we could do more to advocate for other types of policies that would disproportionately benefit these populations. You have given us so much information for us to digest and take too heart and take action on whether that's through something that we're doing in our individual clinical practices whether we're doing some advocacy work is there anything that you would suggest to our audience to get more involved or find more information any resources you might suggest. Yeah so there are a number of resources and I think that's what's great now I can't say the same thing maybe 10 years ago it was not as extensive the resources for sexual gender minority health but there's a number of organizations that have trainings and resources for nurses so one of them is the gay and lesbian medical association has actually prints out or they publish a handbook for how to provide inclusive care for LGBTQ people that people can access online I think I think it's a book that you can purchase but it's sort of created by this interdisciplinary group of providers that care about and care about the needs of LGBTQ people. The gay and lesbian medical association also has a wonderful resource of provider directory of providers that they've sort of vetted that are LGBTQ affirming providers so if you're in an area that doesn't have a lot of psychotherapists or even psychiatric nurse practitioners that have expertise in LGBTQ health you can actually go on the website for the gay and lesbian medical association and try to find a provider to link your patient with the types of services that they would really like that's one resource through the National LGBTQIA Education Center there are dozens of free modules these continuing education modules on a number of different topics related to sexual and gender minority health anything from transgender up transgender care gender affirming hormone therapy is the care of LGBTQ older adults a number of different resources that I think nurses can really access and potentially even use in educating their nursing students assign some of the modules to their students I think would provide a good introduction to LGBTQ health so there's a number of resources and of course local LGBTQ organizations are happy to partner with nurses to do a health fair a blood pressure screening a session where they have a nurse and comes and talks about the importance of I don't know having a healthy diet so I think that there is a lot of sort of openness from the community because they they have for so long been an underserved and understudied population that I think there's a real sort of like hunger to have access to these resources from trusted health care providers and who better to provide that than nurses I think well we've been speaking with Dr. Billik Caceris and we look forward to learning more and thank you so very much for being with us today this is your host Jarlyn Worrfield and we will see you next time thank you for listening to heart to heart nurses we invite you to visit pcna.net for clinical resources continuing education and much more [BEEP]