Billy A. Caceres, Ph.D., R.N., FAHA, Chair of the writing group for the American Heart Association Scientific Statement: LGBTQ heart health, “Assessing and Addressing Cardiovascular Health in Lesbian, Gay, Bisexual, Transgender and Queer (or Questioning) Adults and assistant professor, Columbia University School of Nursing, New York, New York. Offering perspective on AHA Scientific Sessions 2020 Presentation P2274 copyright American Heart Association 2020 "I think there's probably several factors that contribute to some of these undiagnosed or untreated issues that we see among transgender adults. So there's an extensive literature that shows that transgender individuals, tend to have higher rates of poor mental health including things like depression and anxiety but a lot less is known about cardiovascular disease risk factors like hypertension or hyperlipidemia. I think one of the factors that might contribute to these higher rates of undiagnosed or undertreated cardiovascular conditions, is the lower rates of health insurance that we see among the transgender community. And that is partially attributed to higher rates of poverty and financial strain, that have been documented in the population compared to their non transgender peers. And I think that those two things together contribute to transgender people potentially not having proper access or even be able to seek proper care in terms of prevention or even secondary prevention once they know that they have a condition like hypertension. I think another factor which has been documented is that, the majority of transgender people, I think it's over 70%, report having experienced discrimination from a healthcare provider. And I think that, that on top of what we see, in terms of low rates of health insurance and higher rates of poverty, the fear of potential discrimination from healthcare providers further contributes to transgender individuals maybe not seeking care for preventative issues like screening for hypertension or screening for hyperlipidemia."