Hormones, stress, and heart disease in transgender women with HIV in LITE Plus

Tonia C Poteat; Molly Ehrig; Hedyeh Ahmadi; Mannat Malik; Sari L Reisner; Asa E Radix; Jowanna Malone; Christopher Cannon; Carl G Streed Jr; Mabel Toribio; Christopher Cortina; Ashleigh Rich; Kenneth H Mayer; L Zachary DuBois; Robert-Paul Juster; Andrea L Wirtz; Krista M Perreira

doi:10.1016/j.amepre.2024.10.001

Hormones, stress, and heart disease in transgender women with HIV in LITE Plus

Am J Prev Med. 2024 Oct 8:S0749-3797(24)00343-X. doi: 10.1016/j.amepre.2024.10.001. Online ahead of print.

Authors

Tonia C Poteat¹, Molly Ehrig², Hedyeh Ahmadi³, Mannat Malik⁴, Sari L Reisner⁵, Asa E Radix⁶, Jowanna Malone⁷, Christopher Cannon⁷, Carl G Streed Jr⁸, Mabel Toribio⁹, Christopher Cortina¹⁰, Ashleigh Rich¹¹, Kenneth H Mayer¹², L Zachary DuBois¹³, Robert-Paul Juster¹⁴, Andrea L Wirtz¹⁵, Krista M Perreira¹⁶

Affiliations

¹ Division of Healthcare in Adult Populations, Duke University School of Nursing, Durham, NC, USA. Electronic address: tonia.poteat@duke.edu.
² Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
³ University Statistical Consulting, Irvine, CA, USA.
⁴ Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
⁵ Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA; The Fenway Institute, Fenway Health, Boston, MA, USA.
⁶ Callen Lorde Community Health Center, New York, NY, USA; Epidemiology Department, Columbia University Mailman School of Public Health, New York, NY, USA.
⁷ Whitman-Walker Institute, Washington, DC, USA.
⁸ Department of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA; GenderCare Center, Boston Medical Center, Boston, MA.
⁹ Metabolism Unit, Massachusetts General Hospital, Boston, MA, USA.
¹⁰ Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
¹¹ Division of Healthcare in Adult Populations, Duke University School of Nursing, Durham, NC, USA.
¹² The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA.
¹³ Department of Anthropology, University of Oregon, Eugene, OR, USA.
¹⁴ Department of Psychiatry and Addictology, University of Montreal, Montreal, Canada.
¹⁵ Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
¹⁶ Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.

PMID: 39389223
DOI: 10.1016/j.amepre.2024.10.001

Abstract

Introduction: Cardiovascular disease (CVD) is a leading cause of death among transgender women and people with HIV. Exogenous estrogen and psychosocial stressors are known risk factors for CVD. Yet, few studies have used biomarkers to examine the role of stress in CVD risk among transgender women with HIV (TWHIV). This analysis examined whether stress moderates relationships between gender-affirming hormone therapy (GAHT) duration and CVD risk among TWHIV.

Methods: This cross-sectional analysis of baseline data from an observational cohort of 108 Black and Latina TWHIV in Boston, New York, and Washington, DC, enrolled December 2020 - June 2022, measured socio-demographics, medical diagnoses, medications, smoking history, and perceived stress via interviewer-administered surveys. Physiological stress was measured with 14 biomarkers to calculate allostatic load indices (ALI). Forty participants provided saliva samples used to calculate cortisol awakening response and cortisol daily decline. The 2018 American College of Cardiology revised pooled cohort equation estimated 10-year CVD risk. Data were analyzed in 2024.

Results: GAHT duration was positively associated with CVD risk scores in bivariate regression. In multivariable linear regression models (adjusting for age, income, education), only age and ALI remained significantly associated with CVD risk scores [β 1.13, CI: 1.05, 1.21]. No stress measure significantly interacted with GAHT duration to affect CVD risk scores. In visual plots, GAHT duration increased CVD risk scores only for TWHIV experiencing the highest ALI.

Conclusions: Stress plays an important role in CVD in TWHIV. More research is needed on non-GAHT factors, which influence CVD health among transgender women.

Keywords: HIV comorbidities; allostatic load; cortisol; exogenous estrogen; transgender women.