An Integrative Review of Cardiovascular Disease in Lesbian, Gay, and Bisexual Adults

Purpose:

Social conditions and related psychosocial stressors compromise the health of lesbian, gay, and bisexual (LGB) people across the lifespan (Institute of Medicine [IOM], 2011). Indeed, homosexuality remains a criminal offense punishable by jail time and/or death in many countries therefore leading to concealment of sexual orientation and significant fear among LGB individuals (International Lesbian, Gay, Bisexual, Trans, and Intersex Association, 2015). Experiences with discrimination are associated with negative health outcomes, decreased life expectancy, and increased mortality in this population (IOM, 2011). Cardiovascular disease is the leading cause of death worldwide and research suggests that LGB individuals may have higher levels of cardiovascular disease (CVD) risk factors (including obesity, tobacco use, alcohol use, and psychosocial factors) than heterosexual adults (IOM, 2011). However, there is a dearth of literature on CVD risk and occurrence in LGB adults.  

Methods:

An integrative review of the literature on CVD in LGB adults. A thorough literature search of Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, LGBT Life, PsycInfo, PubMed, Scopus, and Web of Science was performed. Studies were included if published between 1985-2015 and compared CVD risk factors and/or occurrence in LGB adults to heterosexual adults. 

Results:

A total of 32 potential studies were identified and the 28 meeting eligibility criteria were included in this integrative review. Only three of the included studies were conducted outside of the United States. A total of 22 studies were secondary data analyses of self-reported data. Participants were young with a mean age range of 28-41 years in 25 studies. Results related to CVD (including hypertension, diabetes, and high cholesterol) were conflicting. However, LGB adults displayed elevated risk factors for CVD. Compared to heterosexual women, lesbian and bisexual women exhibited increased body mass index, waist circumference, substance use, and poor mental health. Gay and bisexual men had increased substance use and poor mental health compared to heterosexual men. Although stress was proposed as a risk factor for CVD disparities in several studies, it was only measured in four studies. LGB individuals report higher levels of victimization and discrimination compared to heterosexuals, which may contribute to poor mental health. However, the impact of victimization and discrimination on CVD risk in LGB adults remains poorly articulated. 

Conclusion:

Social conditions appear to exert a negative effect on the health of LGB people. Although few differences in CVD diagnoses were found, an elevated risk for CVD in LGB adults was identified. These results can help guide nurse-led primary and secondary CVD prevention interventions in the LGB population.