{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T06:04:40Z","timestamp":1780639480036,"version":"3.54.1"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Cardiovascular disease is the leading cause of death in the United States and has garnered several avenues of efforts to reduce incidence and mortality in patient populations. There has also been an increase in reported populations of transgender and gender diverse individuals as well as a reported increased risk for cardiovascular disease in this population. Despite this, there is no current research assessing warning signs of myocardial infarction and no standard of care exists for educating transgender and gender diverse individuals regarding their heart health. This article reviews the known literature on interactions between gender affirming hormone therapy and cardiovascular disease and highlights the need for more research of myocardial infarction onset symptoms in transgender and gender diverse populations to provide better heart health education and care.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1856093","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:40:03Z","timestamp":1780638003000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Data gaps for symptoms of myocardial infarction in transgender and gender diverse patients: a brief literature review and call to action"],"prefix":"10.3389","volume":"14","author":[{"given":"Darren","family":"Schoenike","sequence":"first","affiliation":[{"name":"Arkansas College of Osteopathic Medicine, Arkansas Colleges of Health Education, Fort Smith","place":["AR, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin B.","family":"Yoakum","sequence":"additional","affiliation":[{"name":"Department of the Anatomical Sciences, Arkansas Colleges of Health Education, Fort Smith","place":["AR, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne L.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Department of the Anatomical Sciences, Arkansas Colleges of Health Education, Fort Smith","place":["AR, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"B1","unstructured":"Understanding Nonbinary People: How to Be Respectful and Supportive | A4TE [Internet]\n          \n          \n            \n              Advocates\n              for Trans Equality"},{"key":"B2","doi-asserted-by":"publisher","first-page":"3869","DOI":"10.1210\/jc.2017-01658","article-title":"Endocrine treatment of gender-dysphoric\/gender-incongruent persons: an endocrine society* clinical practice guideline","volume":"102","author":"Hembree","year":"2017","journal-title":"J Clin Endocrinol Metab."},{"key":"B3","doi-asserted-by":"publisher","first-page":"bvab011","DOI":"10.1210\/jendso\/bvab011","article-title":"Hormone therapy, mental health, and quality of life among transgender people: a systematic review","volume":"5","author":"Baker","year":"2021","journal-title":"J Endocr Soc."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1652","DOI":"10.1080\/00918369.2023.2186759","article-title":"Highs, lows, and hormones: a qualitative metasynthesis of transgender individuals' experiences undergoing gender-affirming hormone therapy","volume":"71","author":"Fowler","year":"2024","journal-title":"J Homosex."},{"key":"B5","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1089\/trgh.2020.0094","article-title":"The effect of gender-affirming hormones on gender dysphoria, quality of life, and psychological functioning in transgender individuals: a systematic review","volume":"8","author":"van Leerdam","year":"2023","journal-title":"Transgender Health."},{"key":"B6","unstructured":"2025"},{"key":"B7","doi-asserted-by":"publisher","first-page":"3629","DOI":"10.1093\/eurheartj\/ehy638","article-title":"Funding of cardiovascular research in the USA","volume":"39","author":"Nicholls","year":"2018","journal-title":"Eur Heart J."},{"key":"B8","doi-asserted-by":"publisher","first-page":"61","DOI":"10.2147\/RMHP.S7500","article-title":"Improving health outcomes with better patient understanding and education","volume":"3","author":"Adams","year":"2010","journal-title":"Risk Manag Healthc Policy."},{"key":"B9","unstructured":"2025"},{"key":"B10","unstructured":"Heart Attack Symptoms in Women\n          \n          \n            \n              American\n              Heart Association\n            \n          \n          \n          2024"},{"key":"B11","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/0002-8703(86)90155-9","article-title":"Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population","volume":"111","author":"Lerner","year":"1986","journal-title":"Am Heart J."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1010","DOI":"10.1016\/j.ahj.2003.12.036","article-title":"Public recognition of major signs and symptoms of heart attack: seventeen states and the US Virgin Islands, 2001","volume":"147","author":"Greenlund","year":"2004","journal-title":"Am Heart J."},{"key":"B13","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.yfrne.2017.04.001","article-title":"Sex differences in cardiovascular disease - impact on care and outcomes","volume":"46","author":"Humphries","year":"2017","journal-title":"Front Neuroendocrinol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1161\/CIRCULATIONAHA.117.031650","article-title":"Sex differences in the presentation and perception of symptoms among young patients with myocardial Infarction","volume":"137","author":"Lichtman","year":"2018","journal-title":"Circulation."},{"key":"B15","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1016\/j.annemergmed.2012.05.008","article-title":"Examining the signs and symptoms experienced by individuals with suspected acute coronary syndrome in the Asia-Pacific region: a prospective observational study","volume":"60","author":"Greenslade","year":"2012","journal-title":"Ann Emerg Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"e013739","DOI":"10.1161\/JAHA.119.013739","article-title":"Closing the gap on sex disparity in acute coronary syndrome: is it time to reconsider our definitions of \u201ctypical\u201d?","volume":"8","author":"Alraies","year":"2019","journal-title":"J Am Heart Assoc."},{"key":"B17","doi-asserted-by":"publisher","first-page":"e015539","DOI":"10.1161\/JAHA.119.015539","article-title":"Typical and atypical symptoms of acute coronary syndrome: time to retire the terms?","volume":"9","author":"DeVon","year":"2020","journal-title":"J Am Heart Assoc."},{"key":"B18","doi-asserted-by":"publisher","first-page":"e012307","DOI":"10.1161\/JAHA.119.012307","article-title":"Presenting symptoms in men and women diagnosed with myocardial infarction using sex-specific criteria","volume":"8","author":"Ferry","year":"2019","journal-title":"J Am Heart Assoc."},{"key":"B19","doi-asserted-by":"publisher","first-page":"3665","DOI":"10.3390\/ijerph16193665","article-title":"Knowledge and poor understanding factors of stroke and heart attack symptoms","volume":"16","author":"Han","year":"2019","journal-title":"Int J Environ Res Public Health."},{"key":"B20","doi-asserted-by":"publisher","first-page":"e136","DOI":"10.1161\/CIR.0000000000001003","article-title":"Assessing and addressing cardiovascular health in people who are transgender and gender diverse: a scientific statement from the American Heart Association","volume":"144","author":"Streed","year":"2021","journal-title":"Circulation."},{"key":"B21","doi-asserted-by":"publisher","first-page":"g7873","DOI":"10.1136\/bmj.g7873","article-title":"High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study","volume":"350","author":"Shah","year":"2015","journal-title":"BMJ."},{"key":"B22","doi-asserted-by":"publisher","first-page":"e618","DOI":"10.1161\/CIR.0000000000000617","article-title":"Fourth universal definition of myocardial infarction (2018)","volume":"138","author":"Thygesen","year":"2018","journal-title":"Circulation."},{"key":"B23","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1016\/j.eprac.2023.03.003","article-title":"A national survey of United States-based endocrinologists who prescribe gender-affirming hormone therapy","volume":"29","author":"Bisno","year":"2023","journal-title":"Endocr Pract."},{"key":"B24","doi-asserted-by":"publisher","first-page":"256","DOI":"10.7326\/M17-0577","article-title":"Cardiovascular disease among transgender adults receiving hormone therapy: a narrative review","volume":"167","author":"Streed","year":"2017","journal-title":"Ann Intern Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.eprac.2020.11.001","article-title":"Cardiovascular health maintenance in again individuals: the implications for transgender men and women on hormone therapy","volume":"27","author":"Slack","year":"2021","journal-title":"Endocr Pract."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1001\/jamacardio.2022.3299","article-title":"Distribution of high-sensitivity cardiac troponin and n-terminal pro\u2013brain natriuretic peptide in healthy transgender people","volume":"7","author":"Greene","year":"2022","journal-title":"JAMA Cardiol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"e2537205","DOI":"10.1001\/jamanetworkopen.2025.37205","article-title":"High-sensitivity cardiac troponin I following gender-affirming hormone therapy in transgender adults","volume":"8","author":"Cheung","year":"2025","journal-title":"JAMA Netw Open."},{"key":"B28","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.cca.2022.12.003","article-title":"Concentration of hs-troponin in small cohort of transgender patients","volume":"539","author":"Boone","year":"2023","journal-title":"Clinica Chimica Acta."},{"key":"B29","doi-asserted-by":"publisher","first-page":"100816","DOI":"10.1016\/j.lanwpc.2023.100816","article-title":"Transgender-related stigma and gender minority stress-related health disparities in Aotearoa New Zealand: hypercholesterolemia, hypertension, myocardial infarction, stroke, diabetes, and general health","volume":"39","author":"Veale","year":"2023","journal-title":"Lancet Reg Health West Pac."},{"key":"B30","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1007\/s11883-022-01047-1","article-title":"Transgender cardiovascular health: practical management for the clinician","volume":"24","author":"Ong","year":"2022","journal-title":"Curr Atheroscler Rep."},{"key":"B31","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1007\/s11154-018-9454-3","article-title":"Cardiovascular health in transgender people","volume":"19","author":"Irwig","year":"2018","journal-title":"Rev Endocr Metab Disord."},{"key":"B32","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1530\/EJE-13-0493","article-title":"Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: a case-control study","volume":"169","author":"Wierckx","year":"2013","journal-title":"Eur J Endocrinol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"3914","DOI":"10.1210\/jc.2017-01643","article-title":"Sex steroids and cardiovascular outcomes in transgender individuals: a systematic review and meta-analysis","volume":"102","author":"Maraka","year":"2017","journal-title":"J Clin Endocrinol Metab."},{"key":"B34","doi-asserted-by":"publisher","first-page":"1266","DOI":"10.1161\/HYPERTENSIONAHA.119.13080","article-title":"Gender-affirming hormone therapy, vascular health and cardiovascular disease in transgender adults","volume":"74","author":"Connelly","year":"2019","journal-title":"Hypertension."},{"key":"B35","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1038\/s41569-023-00871-5","article-title":"Improving the cardiovascular health care of transgender and non-binary persons","volume":"20","author":"Restar","year":"2023","journal-title":"Nat Rev Cardiol."},{"key":"B36","author":"Thompson","year":"","journal-title":"Gender-Affirming Hormone Therapy: Testosterone"},{"key":"B37","doi-asserted-by":"publisher","first-page":"4829169","DOI":"10.1155\/2020\/4829169","article-title":"Coronary embolism and myocardial infarction in a transgender male undergoing hormone therapy: a case report and review of the literature","volume":"2020","year":"2020","journal-title":"Case Rep Cardiol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"A792","DOI":"10.1210\/jendso\/bvab048.1611","article-title":"Management of recurrent deep vein thrombosis in a transgender woman","volume":"5","author":"Oguz","year":"2021","journal-title":"J Endocr Soc."},{"key":"B39","doi-asserted-by":"publisher","first-page":"1790","DOI":"10.1111\/jth.14626","article-title":"Transgender patients and the role of the coagulation clinician","volume":"17","author":"Connors","year":"2019","journal-title":"J Thromb Haemost."},{"key":"B40","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1017\/cjn.2018.374","article-title":"Ischemic stroke in a transgender woman receiving estrogen therapy","volume":"46","author":"Kwan","year":"2019","journal-title":"Can Jour Neurol Sci."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1","DOI":"10.24875\/ACME.M23000422","article-title":"Toward a better understanding of cardiovascular risk in the transgender and gender-diverse community: a supplement to the Tijuana declaration","volume":"93","author":"Coss\u00edo-Aranda","year":"2023","journal-title":"Arch Cardiol Mex."},{"key":"B42","doi-asserted-by":"publisher","first-page":"2393","DOI":"10.1007\/s00125-024-06212-6","article-title":"Transgender healthcare: metabolic outcomes and cardiovascular risk","volume":"67","author":"Glintborg","year":"2024","journal-title":"Diabetologia."},{"key":"B43","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1093\/geront\/gnt021","article-title":"Physical and mental health of transgender older adults: an at-risk and underserved population","volume":"54","author":"Fredriksen-Goldsen","year":"2013","journal-title":"Gerontologist."},{"key":"B44","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1161\/CIRCULATIONAHA.122.063156","article-title":"Beyond sex-based medicine in cardiovascular health research and practice","volume":"147","author":"Beach","year":"2023","journal-title":"Circulation."},{"key":"B45","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1016\/j.amjms.2025.08.008","article-title":"Cardiovascular health and gender minority stress in transgender and gender diverse adults: a cross-sectional study","volume":"370","author":"Sowmiyanarayanan","year":"2025","journal-title":"Am J Med Sci."},{"key":"B46","doi-asserted-by":"publisher","first-page":"e2337345","DOI":"10.1001\/jamanetworkopen.2023.37345","article-title":"lin, Lee MS. Sex-specific cardiac troponin thresholds in transgender patients with suspected acute coronary syndrome","volume":"6","author":"Wang","year":"2023","journal-title":"JAMA Netw Open."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1856093\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:40:09Z","timestamp":1780638009000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1856093\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,5]]},"references-count":46,"alternative-id":["10.3389\/fpubh.2026.1856093"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1856093","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,5]]},"article-number":"1856093"}}