Proposed mechanisms of hypertension and risk of adverse cardiovascular outcomes in LGBT communities

Enhancing student understanding of cardiovascular disease burden in marginalized communities in the physiology classroom

Physiology education is at the core of biomedical science and medicine. Physiology unites multiple disciplines to explain the mechanisms whereby a risk factor is associated with disease. Race, ethnicity, sexual orientation, and gender identity are associated with risk of cardiovascular disease (CVD). Minority stress theory attempts to explain the association of identity variables in sex and gender minority (SGM) and Black, Indigenous, and people of color (BIPOC) populations with CVD. However, instruction on how to effectively incorporate the ways that social determinants of health are linked to disease outcomes in marginalized populations, such as the SGM and BIPOC communities, is needed. We investigated the efficacy of teaching minority stress theory concepts in a single lecture in an upper-level cardiovascular pathophysiology course (N = 44 students). To test students' understanding of minority-related disease, we used both subjective and objective measures to evaluate student understanding before and after the lecture. Student self-assessment of understanding of health disparity physiological mechanisms and lifestyle and pharmacological interventions to reduce health disparities in SGM communities increased post intervention. We observed similar results of self-assessment of understanding of health disparity physiological mechanisms and appropriate lifestyle and pharmacological interventions to reduce health disparities regarding the BIPOC community. Our findings suggest that integrating social determinants of health into pathophysiology courses may result in a more inclusive-minded scientific and medical workforce.NEW & NOTEWORTHY Physiology education has historically lacked the inclusion of the social determinants of health and discussion of medically marginalized communities. Here, we show that discussion of cardiovascular disease and psychosocial stress in marginalized communities improves student understanding of the distribution of and causes of cardiovascular disease in marginalized groups. We conclude that more physiology instructors should include discussions on chronic diseases within multiple communities and programs should incorporate social determinants of health into their curricula.

Getting to the Heart of the Matter: Exploring the Intersection of Cardiovascular Disease, Sex and Race and How Exercise, and Gut Microbiota Influence these Relationships

Cardiovascular disease (CVD) is the leading cause of death worldwide, with physical inactivity being a known contributor to the global rates of CVD incidence. CVD incidence, however, is not uniform with recognized sex differences as well and racial and ethnic differences. Furthermore, gut microbiota have been associated with CVD, sex, and race/ethnicity. Researchers have begun to examine the interplay of these complicated yet interrelated topics. This review will present evidence that CVD (risk and development), and gut microbiota are distinct between the sexes and racial/ethnic groups, which appear to be influenced by acculturation, discrimination, stress, and lifestyle factors like exercise. Furthermore, this review will address the beneficial impacts of exercise on the cardiovascular system and will provide recommendations for future research in the field.

Metabolic and cardiovascular risks of hormone treatment for transgender individuals

Identifying metabolic and cardiovascular risks of gender-affirming hormone therapy (GAHT) is challenging due to other confounding variables that affect patient outcomes and the diversity of treatment regimes. Masculinising hormone therapy produces atherogenic lipid profiles, while effects on other metabolic parameters are not consistent. There is insufficient evidence to conclude if cardiovascular disease risk among transmen is increased. The effects of feminising hormone therapy on metabolic parameters do not demonstrate a consistent pattern in the available literature. However, the risk of venous thromboembolism is greater in transwomen than in cis-gender men and women with a possible increase in cardiovascular disease risk. It is recommended to discuss the potential effects of GAHT on cardiovascular health and encourage patients seeking GAHT to adopt a healthy lifestyle. Performing baseline and periodic assessments of cardiovascular risk factors would enable early identification and interventions. In high-risk individuals, the cardiovascular effects of hormonal regimes might impact the treatment decision.

LGBTQ+ cardiovascular health equity: a brief review

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States. Data shows that social drivers of health (SDOH), including economic stability, racial/cultural identity, and community, have a significant impact on cardiovascular morbidity and mortality. LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and other gender and sexual minority) patients face a variety of unique health risk factors and bear a disproportionate burden of CVD compared to cis-gender, heterosexual peers. There is a paucity of research assessing the etiologies of CVD health disparities within the LGBTQ+ community. Herein, we seek to explore existing literature on LGBTQ+ health disparities with a focus on cardiovascular disease, examine trends impacting LGBTQ+ health equity, and identify strategies and interventions that aim to promote LGBTQ+ cardiovascular health equity on a regional and national level.

Sex as a biological variable for cardiovascular physiology

There have been ongoing efforts by federal agencies and scientific communities since the early 1990s to incorporate sex and/or gender in all aspects of cardiovascular research. Scientific journals provide a critical function as change agents to influence transformation by encouraging submissions for topic areas, and by setting standards and expectations for articles submitted to the journal. As part of ongoing efforts to advance sex and gender in cardiovascular physiology research, the American Journal of Physiology-Heart and Circulatory Physiology recently launched a call for papers on Considering Sex as a Biological Variable. This call was an overwhelming success, resulting in 78 articles published in this collection. This review summarizes the major themes of the collection, including Sex as a Biological Variable Within: Endothelial Cell and Vascular Physiology, Cardiovascular Immunity and Inflammation, Metabolism and Mitochondrial Energy, Extracellular Matrix Turnover and Fibrosis, Neurohormonal Signaling, and Cardiovascular Clinical and Epidemiology Assessments. Several articles also focused on establishing rigor and reproducibility of key physiological measurements involved in cardiovascular health and disease, as well as recommendations and considerations for study design. Combined, these articles summarize our current understanding of sex and gender influences on cardiovascular physiology and pathophysiology and provide insight into future directions needed to further expand our knowledge.