A new study published in the journal Circulation: Cardiovascular Quality and Outcomes indicates that transgender men and women have a higher risk of heart attack than people who identify as the gender with which they were born.

Even after adjusting for cardiovascular risk factors, transgender men (who were born biologically female but now identify as male) had more than four times the rate of heart attack as cisgender women (who were born biologically female and identify as female) – 7.2% vs 3.1%. Transgender men also had more than twice the rate of heart attack as cisgender men (who were born biologically male and identify as male).

Transgender women (who were born biologically male and identify as female) had more than twice the rate of heart attack as cisgender women.