"In light of our results, we urge both physicians and transgender individuals to be aware of this increased cardiovascular risk," said study author Dr. Nienke Nota, a researcher in the department of endocrinology at the Amsterdam University Medical Center.
"It may be helpful to reduce risk factors by stopping smoking, exercising, eating a healthy diet and losing weight, if needed, before starting therapy, and clinicians should continue to evaluate patients on an ongoing basis thereafter," Nota said in an American Heart Association news release.
The finding came from a review of medical records concerning more than 2,500 transgender women and nearly 1,400 transgender men undergoing gender transition in Holland.
All had started to receive hormone treatment at some point between 1972 and 2015.
Investigators tracked heart complications for an average of nine years among trans women patients, who had been assigned a male gender at birth and then took hormone therapy to become female.
Stroke risk and heart attack risk among such trans women was pegged as more than double than it was among other women, while stroke risk alone was almost twice that of men.
Deep vein clot risk among trans women was also found to be five times that of other women and 4.5 times that of men, according to the study.
Among the almost 1,400 trans men (assigned female at birth but with male gender identity) who were tracked for an average of eight years, researchers saw a tripling of heart attack risk compared to women.
Why? Investigators said their review was not able to take into account other potential risk factors, including smoking history, dietary habits, exercise routines, and/or mental health issues.
But they pointed to prior research suggesting that estrogen therapy (given to trans women) may increase the risk for clotting and blood vessel inflammation.
Similarly, some studies indicate that testosterone therapy (given to trans men) may make blood cells stickier, while also boosting bad cholesterol levels and lowering good cholesterol.
The findings were published in the Feb. 18 issue of Circulation.
There's more on hormone replacement therapy as part of transitioning treatment at U.K. National Health Service.
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