• Tonia C Poteat, Molly Ehrig, Hedyeh Ahmadi, Mannat Malik, Sari L Reisner, Asa E Radix, Jowanna Malone, Christopher Cannon, Carl G Streed, Mabel Toribio, Christopher Cortina, Ashleigh Rich, Kenneth H Mayer, L Zachary DuBois, Robert-Paul Juster, Andrea L Wirtz, and Krista M Perreira.
• Division of Healthcare in Adult Populations, Duke University School of Nursing, Durham, North Carolina. Electronic address: tonia.poteat@duke.edu.
• Am J Prev Med. 2024 Oct 9.

IntroductionCardiovascular 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.MethodsThis 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 to June 2022, measured sociodemographics, 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.ResultsGAHT 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.ConclusionsStress plays an important role in CVD in TWHIV. More research is needed on non-GAHT factors, which influence CVD health among transgender women.Copyright © 2024 Elsevier Inc. All rights reserved.

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