Sexual orientation, gender identity and cardiometabolic risk: a narrative review

Recent reports estimate that approximately 9% of adults globally identify as a sexual and gender minority (SGM), including lesbian, gay, bisexual, transgender or queer (LGBTQ+) people. While research has shown that SGM populations experience health disparities, few studies have focused on cardiometabolic risk and outcomes, particularly with regard to diabetes and its sequelae. Using narrative review methods, we describe the epidemiology of cardiometabolic risk factors and outcomes in SGM populations, with a focus on literature resulting from meta-analyses and analyses of large samples published between 2017 and 2025. We also propose recommendations for follow-up and monitoring of metabolic and cardiovascular risk in SGM populations. Available data show varying risk for cardiometabolic conditions across SGM subpopulations. Studies of UK data have noted that sexual minority women have an increased risk of diabetes compared with heterosexual women, while data from the USA reveal ambiguous results depending on the data source. Transgender adults were found to be at increased risk for diabetes compared with cisgender comparators in UK data sources but not in US sources. For chronic kidney disease (CKD), risk varied by subpopulation and data source. Notably, SGM subpopulations in the UK were reported to have an increased risk of CKD while similar populations in the USA appear to have no difference in risk compared with cisgender, heterosexual comparators. Similarly, risk for CVD among sexual minority populations varied by data source. However, both US and UK data suggest that transgender adults are at increased risk of CVD. Subsequent research is needed to further characterise these disparities and longitudinal cohort studies must be explicitly inclusive of SGM populations. Ideally, SGM-specific longitudinal cohort studies should be executed to more accurately and effectively characterise cardiometabolic risk, outcomes and potential interventions in these populations.