Sexual Identity, Adverse Life Experiences, and Cardiovascular Health in Women

Background: Adverse life experiences (ALE; e.g., discrimination and sexual abuse) may contribute to cardiovascular disease (CVD) risk in sexual minority women (SMW), but few studies have tested whether ALE explain the association of sexual identity with cardiovascular health (CVH) markers in women. Objective: To examine sexual identity differences in CVH among women and the role of ALE. Methods: In the Epidemiologic Study of Risk in Women (ESTHER), we used multinomial logistic regression to assess sexual identity differences [SMW vs. heterosexual women (reference group)] in CVH markers (ideal vs. poor; intermediate vs. poor) using the American Heart Association’s Life’s Simple 7 and the total score. Next, we tested whether the association of sexual identity with the total CVH score was attenuated by traditional CVD risk factors or ALE. Results: The sample consisted of 867 women (395 heterosexual, 472 SMW). SMW were more likely to have experienced discrimination (p<0.001) and lifetime sexual abuse (p<0.001) than heterosexual women. SMW were also less likely to meet ideal CVH criteria for current tobacco use (AOR 0.43, 95% CI = 0.24–0.73) or intermediate CVH criteria for body mass index (AOR 0.60, 95% CI = 0.40–0.92). SMW had a lower cumulative CVH score (B(SE)= −0.35(0.14), p<0.01) than heterosexual women. This difference was not explained by traditional CVD risk factors or ALE. Conclusions: Smoking, body mass index, and fasting glucose accounted for much of the CVH disparity due to sexual identity, but those differences were not explained by ALE. Health behavior interventions tailored to SMW should be considered.