Sexual Minority Individuals Need Better Tailored CVH Interventions


Potential disparities in care highlight the great need for tailored cardiovascular health (CVH) interventions among bisexual female individuals, according to a recent study.

Overall cardiovascular health (CVH) scores were worse for bisexual female patients compared with heterosexual female patients, according to a new analysis of National Health and Nutrition Examination Survey (NHANES) data.

The study findings, published in JAMA Cardiology1, also note that the CVH of gay males appeared to be better than that of heterosexual males.

“Over the past 2 decades, there has been growing evidence that sexual minority (SM; such as lesbian, gay, and bisexual) adults in the United States are at greater risk of cardiovascular disease than their heterosexual counterparts,” the authors wrote. “The purpose of this cross-sectional study was to examine sexual identity differences in CVH scores among adults in the United States.”

For this study conducted between June 30 and December 14, 2022, the investigators analyzed 2007 to 2016 NHANES data, and they used the American Heart Association’s revised measure of ideal CVH for adult individuals living in the United States (N = 12,180), each metric of which is scored from 0 to 100 (higher scores = better CVH profile). These metrics are diet, physical activity, nicotine exposure, sleep duration, body mass index (BMI), blood lipids, blood glucose, and blood pressure.2 Sexual identity was self-reported as heterosexual, gay/lesbian, bisexual, or something else, noted the authors. Participant mean (SD) age was 39.6 (11.7) years, and 49.5% were female individuals.

Nicotine scores were worse among the lesbian and bisexual female study participants compared with their heterosexual counterparts:

  • Lesbian individuals: B = −17.21 (95% CI, −31.98 to −2.44)
  • Bisexual females: B = −13.76 (95% CI, −20.54 to −6.99)

In addition, BMI scores were less favorable and cumulative CVH scores were lower among bisexual females compared with heterosexual females:

  • BMI score: B = −7.47 (95% CI, −12.89 to −1.97)
  • Cumulative CVH score: B = −2.59 (95% CI, −4.84 to −0.33)

The results differed when comparing outcomes between gay male and heterosexual male individuals. While nicotine scores were less favorable (B = −11.43; 95% CI, −21.87 to −0.99), diet, BMI, and glycemic status scores were better:

  • Diet score: B = 9.65 (95% CI, 2.38-16.92)
  • BMI score: B = 9.75 (95 %CI, 1.25-18.25)
  • Glycemic status score: B = 5.28 (95% CI, 0.59-9.97)

When outcomes pertaining to hypertension diagnosis and needing to use antihypertensive medications, the odds were twice as high for both measures among bisexual compared with heterosexual male individuals:

  • Hypertension diagnosis: adjusted odds ratio (aOR), 1.98 (95% CI, 1.10-3.56)
  • Use of antihypertensives: aOR, 2.20 (95% CI, 1.12-4.32)

The most common ethnicity represented in this study was non-Hispanic White and most participants had some college education, were a college graduate, or had education beyond college.

Additional study findings include the following results:

  • Bisexual females (47.6%) vs heterosexual females (26.7%) were more likely to meet any criteria for depression
  • Bisexual females (6.6%) vs heterosexual females (16.1%) were less likely to receive a hypertension diagnosis
  • Bisexual females and female study participants who self-identified as something else had lower income-to-poverty ratios vs heterosexual females: 2.3 (1.6) vs 3.0 (1.7) and 2.0 (1.5) vs 3.0 (1.7), respectively
  • Bisexual males and male study participants who self-identified as something else were more likely to meet any depression criteria: 40.2% vs 19.0% and 36.5% vs 19.0%, respectively
  • Bisexual males had lower income-to-poverty ratios vs heterosexual males: 2.3 (1.9) vs 3.1 (1.7)

“As the first, to our knowledge, nationally representative study to examine sexual identity differences in ideal CVH among adults in the United States, our findings represent an important contribution to existing research on CVH disparities among sexual minority adults,” the study investigators wrote. “Consistent with our hypotheses, bisexual female individuals had less favorable CVH profiles than heterosexual female individuals.”

They recommend longitudinal research to examine the potential influence of social determinants of health on the sexual identity differences they saw from their analysis and that tailored CVH interventions need to be optimized for individuals who identify as sexual minorities, bisexual female individuals expecially.


1. Caceres BA, Sharma Y, Ravindranath R, et al. Differences in ideal cardiovascular health between sexual minority and heterosexual adults. JAMA Cardiol. Published online February 22, 2023. doi:10.1001/jamacardio.2022.5660

2. American Heart Association adds sleep to cardiovascular health checklist. News release. AHA. June 29, 2022. Accessed March 3, 2023.

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