“The cardiovascular health of lesbian or bisexual women turns out to be significantly worse than that of heterosexual women”

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By John

Jean-Philippe Empana, in his office at the Cardiovascular Research Center (Inserm), in Paris, on May 19, 2023.

Physician and researcher, Jean-Philippe Empana heads, with Xavier Jouven, the Integrative Epidemiology of Cardiovascular Diseases Unit of the National Institute for Health and Medical Research, at the Cardiovascular Research Center in Paris. He coordinated a study, published on May 17 in the Journal of the American Heart Association, which shows that lesbian or bisexual women have lower heart health scores than heterosexual women. In contrast, gay men and, to a lesser extent, bisexual men have better cardiovascular health than heterosexual men.

Why did you work on the health of sexual minorities?

Since 2016, my team has been interested in the new concept of primordial prevention of cardiovascular diseases, the objective of which is to prevent the appearance of risk factors (tobacco, sedentary lifestyle, obesity, diabetes, hypertension, etc.) with the aim of to move towards so-called “ideal” cardiovascular health and thus reduce the risk of these pathologies. It is located upstream of the classic so-called “primary” prevention, which consists of acting on risk factors that are already present.

While working on this approach, we observed that less than 10% of the general population had “ideal” cardiovascular health and, in the interests of fairness, we began to work on the disparities in this area. At the same time, over the past twenty years, studies carried out in the United States and the Netherlands have revealed differences in terms of risk factors [d’accident] cardiovascular according to sexual orientation. But they only looked at one risk factor at a time. We wanted to know what was happening in France by having a more global approach to cardiovascular health.

How did you proceed?

Three research teams are involved, mine, with in particular Omar Deraz, doctoral student in the team and who is at the origin of the project; that of the epidemiologists Marie Zins and Marcel Goldberg, at the origin of the Constances research platform; and three American researchers who had already worked on the subject on American populations. Constances is a cohort that recruited 200,000 adults aged 18 to 64 in around twenty health examination centers in France, between 2012 and 2020.

In addition to a health check, the participants answered a specific questionnaire on their sexual orientation. For women and men, we thus constituted four groups: heterosexual, homosexual (gay or lesbian), bisexual and “not wishing to express themselves”.