Bisexual women were half as likely as their heterosexual peers to have high scores on a scale measuring cardiovascular health, new research from Columbia University School of Nursing shows.

"Our findings support previous evidence of the heightened risk of heart disease among bisexual individuals and provide important insights to improve heart disease prevention for these individuals," said Billy Caceres, Ph.D., an assistant professor at the nursing school and lead author of the study, "Differences in Ideal Cardiovascular Health Between Sexual Minority and Heterosexual Adults," published online February 22 in JAMA Cardiology.

There is growing evidence that sexual minority (SM) adults have worse cardiovascular health than their heterosexual peers, Caceres and his colleagues note, likely in part due to stress they experience as members of a minoritized group. Health and behavioral factors also contribute, they add. SM men and women are more likely to be current or past smokers, while SM women have a higher risk of obesity, diabetes, and short sleep.

To look at heart health more comprehensively, Caceres and his colleagues used the American Heart Association's (AHA) cardiovascular health (CVH) score, which measures heart risks on a scale from 0-100, with a score of 100 indicating "ideal" heart health.

The score is based on AHA's recommendations for "Life's Essential Eight," four health behaviors: diet, physical activity, smoking, and sleep; and four health factors: body mass index (BMI), cholesterol levels, blood sugar, and blood pressure, associated with heart disease and mortality.

Caceres and his colleagues analyzed 2007-2016 data from the National Health and Nutrition Examination Survey (NHANES) to calculate cardiovascular health (CVH) scores combining all eight risk factors for 12,180 adults aged 18 to 59. About half were female, and two-thirds were non-Hispanic white.

Bisexual women were more likely to be obese than heterosexual women, while bisexual men were at higher risk than heterosexual men of having hypertension and using blood pressure medication, they found. Bisexual and lesbian women had higher scores for nicotine exposure than heterosexual women, while bisexual women had less favorable BMI scores and lower heart health scores than heterosexual women.

Overall, the authors found, bisexual women were about half as likely to have a high heart health score (in the 80-100 range) versus a low score (0-49) compared to heterosexual women. However, gay men had a more favorable cardiovascular health profile than their heterosexual peers, and bisexual men had more favorable cholesterol levels.

Bisexual women are the sexual identity group most likely to live in poverty, and they are more likely to delay health care due to financial issues and to have difficulty finding a health care provider, Caceres and his colleagues note.

"There is a need for tailored interventions to improve the CVH of SM individuals, particularly bisexual women. Investigators should conduct longitudinal research that examines social determinants that may explain the sexual identity differences observed in this study," they conclude.

Other study authors from Columbia Nursing, all affiliated with the school's Center for Sexual and Gender Minority Health Research, include Yashika Sharma, Ph.D. candidate; Rohith Ravindranath, research assistant; and Danny Doan, research coordinator.

--Columbia University School of Nursing