Trauma may rank alongside tobacco use, binge drinking, and overeating as a potential risk factor for cardiovascular disease (CVD) in lesbian and bisexual women, new research suggests. Among more than 500 sexual-minority women, childhood trauma, including abuse and parental neglect, was as an independent risk factor for diabetes, increasing the odds by 58%.

Adult and lifetime trauma also emerged as independent predictors of obesity and hypertension, raising the odds by 16% to 30% in a study to be presented this week at the American Heart Association Scientific Sessions 2018.

"The big first step in this is assessing a patient's sexual identity," said principal investigator Billy A. Caceres, Ph.D., RN, Columbia University School of Nursing, New York City. "I think every provider probably has taken care of a lesbian or bisexual woman, whether they know it or not," he said.

"And it is important if we are taking care of people in this population to know what cardiovascular risk factors might be elevated because we don't readily assess for things like experiences of trauma," Caceres said.

Lesbian and bisexual women are known to have higher rates than heterosexual women of CVD risk factors, such as tobacco use, obesity, and hyperglycemia. Interpersonal trauma is also thought to increase CVD risk, but few studies have examined its effect in sexual-minority women, said Caceres.

Estimates are that of the 11 million Americans who are lesbian, gay, bisexual, or transgender (LGBT), 5 million identify as sexual-minority women. "Yet even in institutions where sexual identity was part of the electronic health record, only 13% to 17% of physicians were asking the question, "he said.

Caceres and his team did a secondary analysis of data on 547 lesbian and bisexual women who participated in the third wave of the Chicago Health and Life Experiences of Women (CHLEW) study, which is the longest-running study of sexual-minority women's health. Now in its fourth wave, wave 3 had an added focus on bisexual, younger, and Black and Latina women.

About a third of participants were 18 to 30 years of age, 36% were black, 22% were Latina, and 71.3% had healthcare insurance. Self-reported rates of obesity, hypertension, and diabetes were 38.8%, 17.7%, and 8.4%.

Cumulative childhood trauma

Cumulative childhood trauma was rated according to experiences of physical abuse, sexual abuse, and parental neglect, with a score of 0 indicating that the participant reported none of the three types of trauma and a score of 3 indicating that the participant reported all three types. In all, 19.7% of women had a score of 0, 40.2% a score of 1, 33.3% a score of 2, and 6.8% a score of 3.

Cumulative adulthood trauma was rated according to experiences of physical abuse, sexual abuse, and intimate partner violence, with 38.2%, 31.3%, 20.8%, and 9.7% of women, respectively, having scores of 0, 1, 2, and 3.

Cumulative lifetime trauma, or the sum of the previous two scales, was scored on a 6-point scale, with 12.0% of women having a score of 0, 45.6% a score of 1 or 2, 33.8% a score of 3 or 4, and 8.6% a score of 5 or 6.