Women who identify as lesbian or bisexual may have a greater risk for heart disease, according to a new study by the American Heart Association (AHA). 

Gay and bisexual men, on the other hand, are usually at lower risk of heart disease than men who identify as heterosexual, the study authors found — as long as those gay and bisexual men don’t live in rural areas. 

The first-of-its-kind study, published in the Journal of the American Heart Association, reveals the complex relationship between sexuality and the risk factors for cardiovascular diseases, a broad category of health conditions that includes heart attacks, stroke, atherosclerosis (hardening of the arteries), heart failure and arrhythmias.

Researchers believe there may be a number of explanations for the differences in heart disease risk between heterosexuals and people who identify as gay or bisexual.

For example, earlier studies suggest that gays and lesbians may experience more mental health issues and are more likely to delay health care than heterosexuals. 

“In view of previous evidence, these findings may be explained at least partially by living conditions, such as poverty, degraded working conditions, mental health challenges, discrimination and/or bad past experiences in the health system,” said lead study author Omar Deraz, a researcher and Ph.D. candidate with the French National Institute of Health and Medical Research and the Paris Cardiovascular Research Center’s Integrative Epidemiology of Cardiovascular Disease Team, in a news release. 

The research team gained the insights by looking at health information for more than 169,400 adults throughout France, 54% of whom were women, using the AHA’s “Life’s Essential 8” criteria, which includes factors such as diet, activity levels, sleep patterns, blood pressure and cholesterol levels.

The research, named the CONSTANCES study, began recruiting participants in 2012, and each participant had clinical examinations and lab tests at the beginning of the study period and every four years thereafter until 2020.

The analysis found that women overall had better cardiovascular health than men, regardless of sexual orientation, but when compared with heterosexual women, those women who identified as lesbian or bisexual had lower overall cardiovascular health.

Increased contact with medical professionals during pregnancy might account for some of the difference, though the small number of lesbians who reported ever being pregnant makes interpretation difficult.

Conversely, gay and bisexual men had significantly better cardiovascular health than heterosexual men if the gay men lived in urban areas.

The researchers suggested that gay men residing in rural locales might be subject to more stressors, such as discrimination, sleep problems or other concerns that could impact their cardiovascular health.

The results confirm the findings of other research.

In the National Health and Nutrition Examination Survey (NHANES), bisexual women had worse cardiovascular health scores than heterosexual women, mostly attributed to cigarette smoking and higher body mass index (BMI), according to research published in February 2023.

And in 2020, the AHA found a wide range of health stressors among sexual minorities such as discrimination, violence, family rejection and — particularly among racial or ethnic minorities — higher levels of poverty, insecure housing and fewer health care options.