21% hypertension prevalence in transgender adults: meta-analysis of cardiovascular morbiditiesTransgender adults face high rates of heart disease

Frontiers in Medicine Published July 15, 2026 Study authors: Mallicka Mallicka, Deep Shikha, Sai Chandan Das, Richa Sinha DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Interpret these prevalence estimates cautiously due to high heterogeneity and potential publication bias.

This meta-analysis synthesizes prevalence data from observational studies to estimate the burden of major cardiovascular morbidities among transgender adults aged ≥18 years. The primary outcome was pooled prevalence of hypertension, stroke, coronary artery disease (CAD), and myocardial infarction (MI).

Key findings include a pooled hypertension prevalence of 21% (95% CI: 12–36; I² = 99.0%), stroke/CVA prevalence of 5% (95% CI: 3–8; I² = 84.3%), CAD prevalence of 3% (95% CI: 1–19; I² = 98.8%), and MI prevalence of 7% (95% CI: 6–9; I² = 75.5%). All estimates showed high heterogeneity, and funnel plot asymmetry for CAD and MI suggested potential publication bias.

The authors note that these are observational data, so results represent associations, not causation. No information on sample size, setting, interventions, comparators, or follow-up was reported. Safety data were not reported.

Practice relevance: The findings suggest a substantial burden of cardiovascular morbidity among transgender individuals, warranting routine screening and targeted preventive strategies. However, clinicians should interpret the prevalence estimates cautiously given the high heterogeneity and potential bias.

How this fits prior evidence

This meta-analysis extends prior coverage on cardiovascular disease in special populations. Prior items focused on interventions for coronary artery disease (DCBs vs DES, postoperative education, tirofiban in stroke) but did not address baseline cardiovascular risk in transgender adults. The current findings provide prevalence estimates that can inform screening strategies, complementing prior evidence on treatment efficacy. The high heterogeneity and publication bias noted here contrast with the more controlled trial settings of prior interventional studies.

A new analysis of existing research finds that transgender adults may face a high burden of cardiovascular disease. The study, a meta-analysis of observational data, looked at the prevalence of major heart conditions in transgender adults aged 18 and older.

Researchers found that 21% of transgender adults had high blood pressure, 7% had a history of heart attack, 5% had a stroke, and 3% had coronary artery disease. These numbers come from combining multiple studies, but the results varied widely across studies, as shown by high statistical heterogeneity.

The analysis has important limitations. It is based on observational studies, so it can show links but cannot prove that being transgender causes these conditions. Also, the researchers noted possible publication bias for coronary artery disease and heart attack, meaning some studies may have been missing from the analysis.

For readers, this study highlights that cardiovascular health is a significant concern for transgender adults. It suggests that routine screening and targeted prevention may be important. However, individual risk depends on many factors, and anyone with concerns should talk to their doctor.

What this means for you:

Transgender adults have high rates of high blood pressure and heart disease, but more research is needed.

Common questions

What did this study find about transgender adults and heart disease?

The study found that 21% of transgender adults have high blood pressure, 7% have had a heart attack, 5% have had a stroke, and 3% have coronary artery disease.

Is this study proof that being transgender causes heart disease?

No. This is a meta-analysis of observational studies, so it can only show a link, not cause and effect. Many factors could contribute to these rates.

Who was included in this study?

The study included transgender adults aged 18 and older. The exact number of participants was not reported, as it combined results from multiple studies.

What are the limitations of this study?

The study noted possible publication bias for coronary artery disease and heart attack, meaning some studies may have been missing. Also, results varied widely across studies.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJul 2026

View Original Abstract ↓

Transgender individuals represent a marginalised population, often exposed to unique psychosocial stressors, limited healthcare access, and social exclusion, all of which may contribute to an increased risk of cardiovascular disease (CVD). However, evidence focusing exclusively on the cardiovascular outcomes in this group remains limited. This systematic review and meta-analysis aimed to estimate the pooled prevalence of major cardiovascular morbidities among transgender adults. A systematic search of five databases (PubMed, PubMed Central, Embase, Scopus, and Google Scholar) was conducted to identify observational studies reporting cardiovascular outcomes in transgender individuals aged ≥18 years. The study protocol was registered with PROSPERO (CRD42022383213). The inclusion criteria were cross-sectional, cohort, and case-control studies published in English. Data extraction and quality assessment were independently performed by two reviewers using standardised tools. A meta-analysis was conducted using a random-effects model, and publication bias was assessed using funnel plots and Egger's test. 10 eligible studies that focused on transgender individuals were included in the final analysis. The pooled prevalence rates were hypertension 21% (95% CI: 12–36; I2 = 99.0%), stroke/CVA 5% (95% CI: 3–8; I2 = 84.3%), coronary artery disease (CAD) 3% (95% CI: 1–19; I2 = 98.8%), and myocardial infarction (MI) 7% (95% CI: 6–9; I2 = 75.5%). Funnel plots indicated a symmetrical distribution for hypertension and stroke, suggesting low publication bias, whereas asymmetry was noted for CAD and MI. This review revealed a substantial burden of cardiovascular morbidity among transgender individuals, warranting routine screening and targeted preventive strategies in this population. Policymakers and healthcare providers should consider inclusive approaches to reduce cardiovascular risk. Further longitudinal studies and comparative analyses of cisgender populations are essential for guiding evidence-based interventions. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022383213, identifier: CRD42022383213.

21% hypertension prevalence in transgender adults: meta-analysis of cardiovascular morbiditiesTransgender adults face high rates of heart disease

How this fits prior evidence

Common questions

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