Sexual minority populations and disparities in cardiovascular healthcare

Cardiovascular disease (CVD) remains the leading global cause of death and significant cardiovascular health disparities have been documented. There is growing evidence that sexual minority (SM; e.g. lesbian, gay, bisexual, queer, and other non-heterosexual) people are at higher risk of developing CVD compared to heterosexual people across the lifecourse. The minority stress model of cardiovascular health (CVH) theorizes that minority stressors across multiple levels influence CVD risk in SM people through mediated psychosocial, behavioural, and physiological mechanisms. These mechanisms remain understudied, which has hindered the development of clinical and public health interventions to reduce CVD risk among SM people. The purpose of this state-of-the-art review was to: (i) elucidate the potential mechanisms underlying CVH disparities among SM populations; (ii) analyse research gaps; and (iii) provide suggestions for improving cardiovascular care and identifying potential targets for clinical and public health interventions in this population. The authors identified multilevel determinants, such as minority stressors and interpersonal violence, that have been associated with tobacco use, alcohol use, sleep problems, obesity, and hypertension among SM populations. They conclude that studies investigating CVH disparities among SM people have considerable methodological limitations that must be addressed to improve our understanding of mechanisms underlying CVH disparities in this population. The authors subsequently provide suggestions for improving cardiovascular care and considerations for the development and implementation of interventions to reduce CVD risk among SM people. This review can help cardiovascular clinicians and researchers devise strategies to reduce CVH disparities among SM populations.