Abstract P169: Cardiovascular Disease Incidence among Male Veterans by Sexual Orientation and Race

Introduction: Studies of cardiovascular disease (CVD) in sexual minority (SM) men (i.e., gay, bisexual) vs. heterosexual men are limited by small sample sizes and lack of objective CVD ascertainment. Small samples also hinder study at the intersection of race and sexual orientation on CVD events. We used the Veterans Healthcare Administration Lesbian, Gay, Bisexual, Transgender Electronic Health Record cohort to fill these knowledge gaps. Methods: We studied 919,404 male cisgender veterans who were free of prevalent CVD and classified as SM or non-SM by a natural language processing tool. We defined incident CVD as first instance of AMI, ischemic stroke, cardiac revascularization, or CVD death between baseline and date of death or 8/31/22. We stratified sample statistics by SM status and race. We used Cox proportional hazards regression to assess the intersection of sexual orientation and race with incident CVD; we adjusted for Hispanic ethnicity and age. Based on the minority stress model, non-SM White men were the referent. Results: Within races, traditional CVD risk factors were similarly distributed by SM status but SM men had greater prevalence of stress-associated characteristics like substance use, depression, and anxiety. Heterosexual, gay, and bisexual Asian men had lower CVD risk than non-SM White men, while Black/African American and Multiracial men had persistently increased CVD risk ( Table ). White and American Native gay men had increased CVD risk vs. non-SM White men. With the exception of Asians, all unclassified SM men had increased CVD incidence vs. non-SM White men. Risk was highest in among Black or Multiracial SM men. Conclusion: This is one of the first studies to examine the intersection of sexual orientation and race on CVD risk in male veterans. CVD risk appears increased or decreased in certain racial groups regardless of sexual orientation but this is not always true and invites further study into the mechanisms by which stress results in inequitable CVD events across groups.