Researchers found that LGBTQIA+ patients are almost invisible in major cardiovascular guidelines, despite evidence of unequal heart-health risks. The analysis of 313 documents highlights a practical problem for clinicians and patients alike: important factors such as sexual orientation, gender identity and hormone therapy are too rarely considered in everyday heart-care advice.

Essential Takeaways

  • Only six guidelines included relevant terms: Just 1.9 per cent of the 313 cardiology documents examined mentioned LGBTQIA+ populations or related issues.
  • Risk factors can overlap: Smoking, stress, obesity and poorer blood-sugar control may contribute to unequal cardiovascular outcomes in some LGBTQIA+ groups.
  • Hormone therapy needs clearer guidance: Researchers say cardiovascular advice should better address gender-affirming oestrogen and testosterone treatment.
  • Some guidance is emerging: Recent documents have recognised sexual orientation as a social determinant of health and called for more inclusive research.
  • Privacy matters: Collecting sexual orientation and gender identity data must be voluntary, transparent and securely managed.

A striking silence in heart-care guidance

Cardiovascular disease remains the world's biggest cause of death, yet the documents that steer its prevention and treatment barely mention LGBTQIA+ patients. A review of 313 guidelines published by American, European and international professional bodies found that only six contained any relevant LGBTQIA+ terminology.

That gap matters because guidelines aren't just academic paperwork. They influence how clinicians assess risk, choose treatments and decide which questions to ask. When a population is absent from the wording, its needs can be easier to overlook, even when the underlying evidence is starting to point to differences in health outcomes.

The concern isn't that every patient should be treated as a label. It's that good care needs enough context to spot genuine risks without making assumptions.

The risks are real, but not identical

Research highlighted by the American Heart Association has reported poorer heart-health profiles among some lesbian and bisexual women compared with heterosexual women. Smoking, stress, access to care and other social factors can all shape cardiovascular health, but those influences don't affect every LGBTQIA+ person in the same way.

That distinction is important. LGBTQIA+ communities aren't one uniform group, and a single broad category can hide meaningful differences between sexual orientations, gender identities, ages and ethnic backgrounds. Still, the absence of reliable, consistent data makes those differences harder to study and harder to reflect in clinical recommendations.

Researchers say higher rates of smoking, obesity and less favourable blood-sugar measures in some groups deserve more attention. These aren't reasons for alarm, but they are reasons for better questions and more tailored prevention.

Why hormone therapy belongs in the conversation

Gender-affirming hormone therapy is another area where cardiology guidance remains thin. Oestrogen and testosterone can affect the body in ways that may be relevant to cardiovascular risk, yet the researchers found few major guidelines offering detailed, practical advice for clinicians treating transgender and gender-diverse patients.

That doesn't mean patients should stop prescribed treatment or change medication without medical advice. Instead, it points to the need for clinicians to discuss personal risk factors, blood pressure, smoking, cholesterol and other relevant measures in a respectful, individualised way.

One recent kidney guideline offered a more useful model by discussing gender-affirming hormones, hormonal stages of life and the importance of cultural safety. Its approach suggests that inclusive care doesn't need to be awkward or elaborate. Often, it starts with precise language and a willingness to ask rather than assume.

Better data could lead to better treatment

The researchers identify inconsistent sexual-orientation and gender-identity data collection as a major obstacle. Studies may use different terms, combine groups that shouldn't be combined or leave these details out entirely, making results difficult to compare.

The American Heart Association's reporting on lesbian and bisexual women's heart health also underlines why subgroup data matters. If studies don't recruit enough LGBTQIA+ participants, researchers may miss differences in symptoms, risk factors or treatment responses. The result is a familiar cycle: limited evidence leads to limited guidance, which then makes inclusive care harder to develop.

Adding these details to health records and clinical trials could help, but the process must be handled carefully. Patients should know why information is being collected, who can access it and how it will be protected. Trust isn't a footnote here; it's the foundation.

What inclusive guidelines should look like

The authors call for cardiology organisations to involve LGBTQIA+ health specialists, community advocates and diverse clinicians when writing future recommendations. They also argue that inclusivity should become a formal measure of guideline quality, alongside evidence strength and clinical relevance.

In practice, that could mean clearer advice on hormone therapy, more consistent terminology, better trial recruitment and guidance on respectful communication. It could also help clinicians recognise how social stress, discrimination and access to care may influence heart health without treating identity itself as a disease.

There is a hopeful precedent. Women's cardiovascular health and the experiences of racial and ethnic minority patients were once routinely underrepresented in research and guidance, but sustained pressure and better evidence eventually changed practice. LGBTQIA+ heart health now appears to be reaching a similar turning point.

Small changes in language can make a consultation feel safer, but stronger evidence and clearer guidance can make care safer too.

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