Mapping the cardiovascular burden in transgender individuals: a systematic review and meta-analysis.

BACKGROUND

Transgender individuals represent a marginalised population, often exposed to unique psychosocial stressors, limited healthcare access, and social exclusion, all of which may contribute to an increased risk of cardiovascular disease (CVD). However, evidence focusing exclusively on the cardiovascular outcomes in this group remains limited. This systematic review and meta-analysis aimed to estimate the pooled prevalence of major cardiovascular morbidities among transgender adults.

METHODS

A systematic search of five databases (PubMed, PubMed Central, Embase, Scopus, and Google Scholar) was conducted to identify observational studies reporting cardiovascular outcomes in transgender individuals aged ≥18 years. The study protocol was registered with PROSPERO (CRD42022383213). The inclusion criteria were cross-sectional, cohort, and case-control studies published in English. Data extraction and quality assessment were independently performed by two reviewers using standardised tools. A meta-analysis was conducted using a random-effects model, and publication bias was assessed using funnel plots and Egger's test.

RESULTS

10 eligible studies that focused on transgender individuals were included in the final analysis. The pooled prevalence rates were hypertension 21% (95% CI: 12-36; I 2 = 99.0%), stroke/CVA 5% (95% CI: 3-8; I 2 = 84.3%), coronary artery disease (CAD) 3% (95% CI: 1-19; I 2 = 98.8%), and myocardial infarction (MI) 7% (95% CI: 6-9; I 2 = 75.5%). Funnel plots indicated a symmetrical distribution for hypertension and stroke, suggesting low publication bias, whereas asymmetry was noted for CAD and MI.

CONCLUSION

This review revealed a substantial burden of cardiovascular morbidity among transgender individuals, warranting routine screening and targeted preventive strategies in this population. Policymakers and healthcare providers should consider inclusive approaches to reduce cardiovascular risk. Further longitudinal studies and comparative analyses of cisgender populations are essential for guiding evidence-based interventions.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022383213, identifier: CRD42022383213.