A Systematic Review of Cardiovascular Diseasein Sexual Minorities

Background:Mental health and HIV disparities are well documentedamongsexualminorities,butthereisa dearthofresearchonotherchronicconditions. Cardiovascular disease remains the leading cause of deathworldwide. Although sexual minorities have high rates of several modi-fiable risk factors for cardiovascular disease (including stress, tobacco use,and alcohol consumption), there is a paucity of research in this area.Objectives:In this systematic review, we synthesized and critiqued theexisting evidence on cardiovascular disease among sexual minority adults.Search Methods:We conducted a thorough literature search of 6electronic databases for studies published between January 1985 andDecember 2015 that compared cardiovascular disease risk or prevalencebetween sexual minority and heterosexual adults.Selection Criteria:We included peer-reviewed English-language studiesthat compared cardiovascular disease risk or diagnoses between sexualminority and heterosexual individuals older than 18 years. We excludedreviews, case studies, and gray literature. A total of 31 studies met in-clusion criteria.Data Collection and Analysis:At least 2 authors independently ab-stracted data from each study. We performed quality assessment ofretrieved studies using the Crowe Critical Appraisal Tool.Main Results:Sexual minority women exhibited greater cardiovas-cular disease risk related to tobacco use, alcohol consumption, illicitdrug use, poor mental health, and body mass index, whereas sexualminority men experienced excess risk related to tobacco use, illicitdrug use, and poor mental health. We identified several limitations inthe extant literature. The majority of included studies were cross-sectional analyses that used self-reported measures of cardiovasculardisease. Even though we observed elevated cardiovascular diseaserisk, we found few differences in cardiovascular disease diagnoses(including hypertension, diabetes,and high cholesterol). Overall, 23of the 26 studies that examined cardiovascular disease diagnosesused subjective measures. Only 7 studies used a combination ofbiomarkers and self-report measures to establish cardiovasculardisease risk and diagnoses.AuthorsíConclusions:Social conditions appear to exert a negativeeffect on cardiovascular disease risk among sexual minorities. Al-though we found few differences in cardiovascular disease diagnoses,we identified an elevated risk for cardiovascular disease in both sexualminority men and women. There is a need for research that in-corporates subjective and objective measures of cardiovasculardisease risk.Public Health Implications:Cardiovascular disease is a major healthconcern for clinicians, public health practitioners, and policymakers. Thissystematic review supports the need for culturally appropriate in-terventions that address cardiovascular disease risk in sexual minorityadults.