Multi-disciplinary team wins Women’s Cardiovascular Health Catalyst grant

Blood clots that block the flow of blood either in the deep veins of the arms or legs, or in the lungs (venous thromboembolism [VTE]) are serious and even life threatening. They impact one in 1,000 Canadians and can lead to chronic pain and leg swelling, reduced exercise capacity, reduced quality of life and rarely chronic pulmonary hypertension or death. 

Researchers know that hormone therapy increases the risk of developing VTE in the cisgender population, but when it comes to its impact on transgender women, there are still many questions. 

While it’s reported that transgender women experience higher rates of VTE than their cisgender counterparts, experts aren’t sure of the true prevalence of the condition in this population, nor do they understand the level of risk or the underlying causes.  There are also questions about how to screen, manage and treat VTE in transgender women. 

The Libin Cardiovascular Institute’s Dr. Leslie Skeith, MD, a clinician-scientist specializing in venous thromboembolism, is part of a new, multi-disciplinary University of Calgary research collaboration tackling the issue of VTE in the transgender and gender diverse population. 

She, alongside resident Dr. Hannah Yang, MD, and co-principal investigators Drs. Nathalie Saad, MD, Deepa Suryanarayan, MD, Lorraine Lau, MD, and Shannon Rucyzki, MD, recently received the Libin Cardiovascular Institute’s Women’s Cardiovascular Health Catalyst grant to kickstart a pilot study that they hope will fill this knowledge gap. 

“This is an important topic, because there are many questions when it comes to life-saving gender affirming hormone therapy and the risk of VTE,” says Skeith. “We are still learning about the long-term VTE risk and the safest treatment options for individuals receiving gender affirming hormone therapy.” 

The year-long study will involve 350 patients from Calgary’s Adult Endocrinology Gender Health Program, a multidisciplinary, gender-affirming care clinic for transgender and gender-diverse individuals. The research team’s goals are to better understand the risk of VTE in transgender women and, ultimately, to find ways to decrease this risk and prevent thrombosis. 

Dr. Nathalie Saad, MD, is an endocrinologist and researcher who leads Calgary’s Adult Endocrinology Gender Health Program. She says the project was inspired by her patients. 

“We really don’t understand a lot of things in this population and the research is limited,” she says. “Scientific literature points to an increased risk of VTE and cardiovascular disease in both transgender men and women… but we don’t know why.”

Saad explains this study hopes to shed light on the true incidence of VTE in transgender women, and to understand how the different formulations and delivery methods of gender-affirming hormone therapies (ie oral versus non-oral) impact this risk. 

 “Our hope is that we can optimize the benefits our patients receive from their life-saving therapy, while lowering the risks,” she said. 

Skeith says the pilot project is just a start. The team hopes it will lead to a multi-centre, international study focused on this population and these important questions. 

Dr. Leslie Skeith is an associate professor in the departments of Medicine, Community Health Sciences and Oncology at the Cumming School of Medicine. She is a member of the CSM's Libin Cardiovascular Institute, O'Brien Institute for Public Health and the Alberta Children's Hospital Research Institute.

Dr. Nathalie Saad, MD, is a clinical assistant professor in the Department of Medicine, Division of Endocrinology at the Cumming School of Medicine.