Transgender men and women are more likely to have heart attacks than cis people of the same age and background, according to the research conducted published in Cardiovascular Quality and Outcome. Trans women are twice as likely to have heart attacks as their cis counterparts. In the study, the researchers note trans people may be more likely to have heart attacks because of higher level of stress, healthcare services issues and substance abuse as a consequence of a mental disbalance. The study found that hormonal replacement therapy may put a transgender person at higher risk of heart attacks due to an increase in “inflammatory markers” which can promote blood clots and e risk of these side effects grows proportionally to the person’s age – it is more likely to occur among older trans people than younger ones. The researchers who authored the study say it is the first investigation of a large cohort of transgender people in the United States that looks at their reported medical history.