Project Summary: Guided by current prediction models utilized to address and prevent atherosclerotic cardiovascular disease (CVD), the proposed project investigates how gender identity and hormone therapy are related to cardiovascular health in transgender adults. The projects three specific aims are to: 1) evaluate a robust method of identifying transgender individuals within claims data and compare this method to the gold-standard of self-identification with data from Fenway Health, a federally qualified health center and leader in transgender health; 2) assess current prediction models for CVD (i.e., Pooled Cohort Risk Assessment Equation) utilizing C statistics, net reclassification, and integrated discrimination index for transgender individuals by accounting for sex assigned at birth, gender identity, and use of exogenous hormones.; and 3) examine the knowledge and attitudes of 160 transgender adult regarding potential risks associated with hormone therapy and perceived barriers, facilitators, and acceptability of interventions affecting cardiovascular health. Completing the proposed aims will 1) improve the accuracy of research with administrative data; 2) enhance clinical decision-making for transgender adults seeking hormone therapy; and 3) inform risk mitigation strategies to improve cardiovascular health of transgender adults. By engaging in mentored research with Drs. Emelia Benjamin (Mentor), Michael Paasche-Orlow (Mentor), Howard Cabral (Mentor), and Sari Reisner (Mentor), and collaborators, completing coursework, and participating in seminars, conferences, and regular mentoring meetings, I will develop expertise in four new areas critical to my development as an independent clinician- scientist evaluating health outcomes to characterize and mitigate CVD risks for transgender individuals: 1) Quantitative methods to analyze claims-based & electronic health record data; 2) Quantitative methods to assess prediction models; 3) Clinical skills in transgender endocrinology, cardiology, & preventive care; and 4) Qualitative research & community engagement skills. Moreover, I will extend my grant writing and oral presentation skills by participating in grant writing courses and presenting at research meetings and seminars. Boston University offers junior scholars with the intellectual and practical resources they need to develop into successful independent investigators, including junior faculty seminars, grant writing, editing, and review services, and opportunities for intellectual exchange and collaboration with senior colleagues. A K01 award will provide me with the research experience, skills, and mentorship I need to build a cutting-edge independent research program that assesses and addresses cardiovascular health in sexual and gender minorities, particularly transgender adults.

Project Narrative: Doctors use prediction models to help them prevent heart attacks and stroke in healthy adults. However, these models do not apply to everyone, including transgender and cisgender adults using hormone therapy. This project aims to provide new methods of predicting and preventing heart attacks and strokes in these unique groups of people.