Assessing cardiovascular risk in transgender patients on gender affirming hormonal therapy

Description

The number of transgender individuals seeking gender-affirming care is rising, with studies showing they face higher cardiovascular disease (CVD) risks than cisgender peers. This PhD aims to explore CVD risk in transgender patients on hormone therapy through retrospective and prospective studies. Objectives include building a patient database, assessing existing evidence, and measuring cardiovascular health using specialized techniques.

The number of individuals identifying as transgender has increased substantially in recent years, leading to a notable rise in those seeking gender-affirming medical care to align their secondary sex characteristics with their gender identity. Notably, recent research has highlighted that transgender individuals face a significantly elevated risk of cardiovascular disease (CVD) compared to their cisgender peers. For instance, studies have shown that transgender women are more than twice as likely to experience a heart attack as cisgender women, while transgender men have over four times the risk. A meta-analysis also found that transgender women have a 1.3 times higher incidence of stroke compared to cisgender men. Despite these concerning trends, the underlying mechanisms contributing to this increased cardiovascular risk remain unclear, largely due to the heterogeneity and retrospective nature of the available data. Consequently, it is still challenging to disentangle the specific cardiovascular burden associated with gender-affirming hormone therapy (GAHT) from that of other contributing factors, such as lifestyle.

The aim of this PhD is to explore in a retrospective database and in a prospective study the determinants of the increased risk of CVD in trans gender patients on GAHT and provide mechanistic insights.

Specific objectives are to:

  • Build a database of transgender on GAHT patients for follow up
  • Assess current evidence in available database
  • Measure cardiovascular health in transgender patients on GAHT with technique for vascular stiffens and endothelial dysfunction assessment.

This PhD will be developed in three main  workpackages (WPs):

WP1: In this WP the PhD student will develop a database from the clinical data available in the WIRRAL UNIVERSITY TEACHING HOSPITAL NHS FOUNDATION TRUST. This task will include the download and recording of data from EHR. In this WP the student will identify cohorts of patients on different GAHT.

WP2: In this WP the PhD student will develop methodology to select transgender patients in available database (UK biobank) and apply statistical analysis to investigate the cardiovascular incidence

WP3: This is a clinical WP in which the student will measure arterial stiffness with applied tonometry Pulse Penn and endothelial disfunction through flow mediated dilatation assessment in transgender patients in different GAHT identified in WP1 and compare with a matched population of healthy control.

PhD training: All postgraduate students undertake the PGR Development Programme which aims to enhance their skills for a successful research experience and career. They are required to maintain an online record of their progress and record their personal and professional development throughout their research degree. In addition to monthly supervision meetings, The Liverpool Centre for Cardiovascular Science holds monthly group research meetings where students are given opportunities to present their research. The PhD student will receive training from clinical and academic experts in appropriate methodologies, including Pulse Penn methods for arterial stiffness assessment, conducting systematic reviews, data analysis, academic writing, and applying for ethics approval to conduct clinical researchvScience is fully committed to promoting gender equality in all activities. 

To apply please send CV and cover letter to Dr Riccardo Proietti.