Heart failure & cardiomyopathiesCohort study
Heart Failure Phenotypes and Trajectory by Gender Identity in a National Veteran Cohort
- retrospective cohort study
Authors' conclusion
Gender identity is associated with differences in HF incidence and trajectory among veterans. HF epidemiology may be incompletely characterized without inclusion of TGD populations.
Study context
- Population
- Veterans in the Veterans Health Administration (October 1, 2010-September 30, 2019)veterans, transgender and gender diverse (TGD) status n = 42,157, 3.8%
- Participants
- 1,103,923 veterans
- Exposure
- associations between gender identity, incident heart failure (HF), and trajectories between HF phenotypes
- TGDn = 42,157
Main finding
As reported in the abstract
Incident HF events · median follow-up 9.4 years
TGD
3,078
events
- Total incident HF events
- 107,766
Observational data: associations, not effects.
Further findings
| Outcome | cisgender men | cisgender women | TGD | HR (95% CI) | |
|---|---|---|---|---|---|
| Incident HF rate — TGD vs cisgender women · higher HF risk · Multivariable Cox regression | 13.05 per 1,000 person-years | 3.87 per 1,000 person-years | range across TGD identities 6.22 to 8.89 per 1,000 person-years | 1.53 (1.46–1.60) | |
| Incident HF rate — TGD vs cisgender men · lower HF risk · Multivariable Cox regression | 0.90 (0.86–0.93) | ||||
| 0.512Hazard ratio (log scale) |
- Mean age of TGD veterans
- 46 · mean age · years
HF with reduced ejection fraction (EF) and HF with preserved EF (HFpEF)
- HF with reduced EF rates were intermediate between cisgender men and women
- associations with HFpEF were inconsistent after adjustment
HFpEF with EF decline and HF with improved EF
- Rates of HFpEF with EF decline
- 130.0-163.3 per 1,000 person-years
- Rates of HF with improved EF
- 161.3-262.6 per 1,000 person-years
Original publication
Heart Failure Phenotypes and Trajectory by Gender Identity in a National Veteran Cohort. JACC Adv. Published 2 September 2026. doi:10.1016/j.jacadv.2026.103198
Summarised from the published abstract; every number is checked against it