https://orcid.org/0000-0001-6865-5546
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Billy A Caceres, Yashika Sharma, Danny Doan, Rohith Ravindranath, Vince Nguyen, Ipek Ensari, Joseph Belloir, Yu Zheng Lim, Stephanie Cook, Sexual identity differences in ideal cardiovascular health among cisgender adults in the All of Us Research Program, Annals of Behavioral Medicine, Volume 59, Issue 1, 2025, kaaf032, https://doi.org/10.1093/abm/kaaf032
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Abstract
Cardiovascular health (CVH) disparities have been documented among sexual minority adults, yet prior research has focused on individual CVH metrics. We sought to examine sexual identity differences in CVH using the American Heart Association’s composite measure of ideal CVH, which provides a more comprehensive assessment of future CVD risk.
Data from the All of Us Research Program were analyzed. Sexual identity was categorized as heterosexual, gay/lesbian, bisexual, or other. Individual CVH health metrics and cumulative ideal CVH (range 0-100) were assessed. We ran sex-stratified multiple linear regression models to estimate differences across individual CVH metrics and cumulative ideal CVH between sexual minority and heterosexual adults. We also explored differences in CVH across racial/ethnic and age groups.
The sample included 11 047 cisgender adults with a mean age of 61.1 years (± 13.85); 80% were non-Hispanic White. Lesbian women, gay men, and bisexual women reported greater nicotine exposure than their heterosexual counterparts. Compared to heterosexual men, gay men (B [95% CI] = −8.95 [−14.50, −3.39]) had worse physical activity scores. Gay men also had better body mass index scores than heterosexual men (B [95% CI] = 3.21 [0.09, 6.33]). Bisexual women and men had lower cumulative ideal CVH scores than heterosexual adults. Exploratory analyses revealed several differences in individual CVH metrics and cumulative ideal CVH across racial/ethnic and age groups.
Clinical interventions to improve the CVH of bisexual adults are needed. Findings can inform the design of interventions that are tailored for specific subgroups of sexual minority adults.
Lay Summary
Heart disease is the number one cause of death worldwide. Sexual minority (such as gay/lesbian or bisexual) adults are at greater risk of heart disease than straight adults. Our study examined data from the All of Us Research Program. We used a tool from the American Heart Association to measure heart health. We measured 6 different risk factors for heart disease to calculate total heart health scores for each participant. We then compared differences in heart health between sexual minority and straight adults. Our study included 11 047 adults with an average age of 61. Lesbian women, gay men, and bisexual women had higher levels of nicotine use compared to straight adults. Gay men had lower physical activity than straight men but also had a lower risk of obesity. Bisexual women and men had worse total heart health scores than straight adults. We found several differences in heart health across race/ethnicity and age. Our results indicate that interventions to reduce heart disease risk among bisexual women and men are needed. We also provide new knowledge of which racial/ethnic and age groups of sexual minority adults are at highest risk of heart disease.
