Abstract Body: Non-heterosexual individuals have historically been underrepresented in cardiovascular research, even though there is growing evidence suggesting differences in cardiovascular health (CVH) outcomes compared to heterosexual individuals. The present study investigates CVH metrics across heterosexual, bisexual, and homosexual adults aged 45–74 in the Hamburg City Health Study (HCHS), the largest local health study in the world so far.
We conducted a cross-sectional analysis of N=11.156 participants from the HCHS. A non-heterosexual orientation was reported by n=917 (8.2%) participants, with 709 who reported being bisexual, and 208 homosexual. Key CVH indicators, e.g., smoking, alcohol consumption, blood pressure, lipids, BMI, HbA1c, and antihypertensive medication use, were compared between heterosexual, bisexual, and homosexual participants based on sex assigned at birth using chi-square tests and adjusted linear models.
Smoking prevalence was highest among bisexual (24.8%) and homosexual men (24.6%) compared to heterosexuals (19.4%, p<.001). Lesbian women smoked less than bisexual and heterosexual women (p<.05). Alcohol use was elevated among bisexual women (p<.05). Gay men and lesbian women showed lower rates of heavy drinking (p>.05). Gay men demonstrated more favorable profiles compared to heterosexual men in total cholesterol, systolic BP (5 mmHg lower), BMI, and HbA1c (p<.05 – p<.001). However, they had lower HDL and higher triglycerides (p<.05). Hypertension prevalence was highest in bisexual men and lowest in gay men, despite bisexual men reporting the highest use of antihypertensive medication. (p<.001). Waist-hip ratio was higher in gay men compared to heterosexual men (p<.05).

Sexual orientation appears to be associated with distinct patterns in CVH. While non-heterosexual individuals, especially gay men, exhibited several favorable metabolic indicators, disparities such as higher smoking and triglyceride levels persist. These findings underscore the need for targeted cardiovascular prevention strategies that consider sexual orientation as a social determinant of health. However, the results might not be directly transferable to rural communities or other countries. The study was conducted in an urban setting with an excellent healthcare infrastructure, universal insurance coverage, and a strong local queer community offering extensive health-promoting resources.