Representation of the LGBTQIA+ Patient Community in Cardiovascular Disease Clinical Guidelines.

Cardiovascular disease (CVD) is the leading cause of death worldwide1, yet gaps remain for underrepresented populations in CVD research and clinical guidelines. The LGBTQIA+ community comprises 7% of the U.S. population2, and evidence suggests a higher predisposition to CVD from increased psychosocial stressors, obesity, smoking, and use of gender-affirming therapy5,6. Our study assesses existing CVD clinical guidelines' approach to the LGBTQIA+ community. In total, 313 cardiology clinical guidelines published by American, European, and international societies were reviewed. A systematic search for LGBTQIA+ related terms was conducted; guidelines containing these terms were analyzed. Only six guidelines (1.9%) contain LGBTQIA+-related terms. The 2023 ACC/AHA/ACCP/HRS Atrial Fibrillation Guideline mentions stroke risk reduction therapies should be offered equitably regardless of sex and gender diversity. The 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Chronic Coronary Disease (CCD) Guideline identifies sexual orientation as a social determinant of health (SDOH), which warrants future research on cardiovascular risk in hormone-treated transgender women with established CCD. The 2020 VA/DoD Obesity Guideline recommends research on individual differences, including transgender identity, in predicting bariatric procedure outcomes. The minimal acknowledgment of LGBTQIA+ patients in existing CVD guidelines highlights the need for tailored recommendations to improve outcomes in this community.