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 therapy^5,6. 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.