|
 |
| ORIGINAL ARTICLE |
|
| Year : 2014 | Volume
: 6
| Issue : 1 | Page : 5-7 |
|
|
Association between androgenetic alopecia and coronary artery disease in young male patients
Kamal H Sharma1, Anchal Jindal2
1 Department of Cardiology, U. N. Mehta Institute of Cardiology, B. J. Medical College, Civil Hospital, Ahmedabad, Gujarat, India
2 Department of Dermatology, Sanjay Gandhi Memorial Hospital, New Delhi, India
| Date of Web Publication | 15-Jul-2014 |
Correspondence Address:
Kamal H Sharma
Department of Cardiology, U. N. Mehta Institute of Cardiology, B. J. Medical College, Civil Hospital, Ahmedabad, Gujarat
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0974-7753.136747
 Abstract | | |
Background: Several studies have demonstrated an association between androgenetic alopecia (AGA) and cardiovascular disease. Still controversies exist regarding the association. Are they truly associated? Objective: The purpose of the present study was to assess the prevalence of AGA and establish its association in young (<45 years) Asian Indian Gujarati male patients having coronary artery disease (CAD). Materials and Methods: Case-control prospective multicentric study was carried out on 424 men. Case group consisted of 212 male subjects having CAD (Group 1) and another 212, either sibling or first degree male relative of the case subjects (having no evidence of CAD) were considered as the control group (Group 2). Age, total cholesterol, incidence of diabetes mellitus, and hypertension were similar in both groups. The degree of alopecia was assessed using the Norwood-Hamilton scale for men. Statistical analysis was performed using Chi-square test. Results: AGA was found in 80 (37.73%) young CAD patients (Group 1), whereas 44 (20.7%) of patients had alopecia in the control group (Group 2). There was statistically significant association between male AGA and CAD ( P = 0.001). Odds ratio was 2.70 (95% confidence interval [CI], 1.72 ± 4.26). Statistically significant association was found between high grade baldness (Grades IV-VII) and CAD in young men ( P < 0.05). Odds ratio = 2.36 (95% CI, 1.108 ± 5.033). There is statistically significant association of AGA in young Asian Gujarati male with CAD and the prevalence of AGA in young CAD patient is 37.73%. Conclusion: This study implies early onset AGA in male is independently associated with CAD, though mechanisms need to be investigated. Keywords: Androgenetic alopecia, coronary artery disease, ischemic heart disease
How to cite this article:
Sharma KH, Jindal A. Association between androgenetic alopecia and coronary artery disease in young male patients. Int J Trichol 2014;6:5-7 |
| Introduction | |  |
Androgenetic alopecia (AGA) has been associated with ischemic heart disease (IHD). [1],[2],[3],[4] These are statistically significant, though weak associations ascertained by previously done epidemiological, cohort and case-control studies. [5] Male pattern baldness (MPB) may be the risk factor for cardiovascular disease was first suggested, in 1972, when Cotton et al. indicated an association between cardiovascular diseases and hair loss. [6] No clear mechanistic relation between these could be discovered. [7],[8] High androgen level has been postulated that lead to both AGA and atherosclerosis and thrombosis. [9] Male AGA is inherited as a complex polygenic trait. It has been demonstrated that severe early onset of AGA in young subject (<30 years) have an increased risk of IHD. [2] A study showed that men with higher grades of AGA (vertex), have a higher risk of developing IHD, especially among men having high cholesterol level and hypertension. [3] However, there are discrepancies in regards to the nature of this relationship. Some indicated that the rate of progression, rather than the presence or degree of baldness, was important. [10] Others suggested that the pattern of baldness was relevant, but disagreed on the relative importance of frontal baldness [3] versus vertex baldness. [2],[4] The purpose of the present study was to assess the prevalence of AGA and establish its association in young (<45 years) Asian Indian Guajarati male patients having coronary artery disease (CAD).
| Materials and Methods | | |
Recruitment and data collection
To carry out case-control prospective multicentric study a total of 424 young men aged <45 years belonging to Guajarati Indian community were studied for AGA pattern based on Hamilton-Norwood scale from U.N Mehta Institute of Cardiology and Research and Life care Hospital, Ahmedabad, Gujarat, India during the period of year 2007-2010 [Table 1].
Subjects (cases) were defined as patients with proven CAD either with history or current presentation of acute coronary syndrome (non-ST-segment elevation myocardial infarction or ST-segment elevation myocardial infarction) or angiographically proven CAD (n = 212). Sibling (brother) or first degree male relatives of the case subjects, without any evidence of CAD (no history of CAD and with normal electrocardiogram and echography findings) (n = 212) were evaluated for AGA as control population. Population had similar incidence of hypertension/diabetes mellitus/total cholesterol/age [Table 2]. The diagnosis of male AGA was made on the basis of detailed history and clinical examination. Subjects were classified according to Hamilton-Norwood scale for grading of AGA in males (Grades I-VII). [11] Further, subjects with AGA Grades I-III were considered having low grade AGA and those with AGA Grades IV-VII were regarded to be having high grade AGA.
Statistical analysis
Two tailed test were used. Chi-square test is used as a test for significance for bivariate associations and comparisons. P < 0.05 was considered to be an evidence for statistical significance. We also calculated standard error of difference between two proportions. The significance of difference is found by normal deviate, Z-test.
| Result | | |
Androgenetic alopecia was found in 80 (37.73%) of patients in young CAD patients, whereas 44 (20.7%) of patients had alopecia in the control group. There was statistically significant association between male AGA and CAD (P = 0.001). Odds ratio was 2.70 (95% confidence interval [CI], 1.72 ± 4.26) [Table 3]. Statistically significant association was found between high grade baldness (Grades IV-VII) and CAD in young men (P < 0.05) [Table 4]. Odds ratio = 2.36 (95% CI, 1.108 ± 5.033). | Table 3: Statistically significant association between male AGA and CAD
Click here to view |
 | Table 4: Statistically significant association between young male high grade AGA (Grades IV-VII) and CAD
Click here to view |
| Discussion | | |
Epidemiological studies examining MPB and coronary heart disease (CHD) have tended to support a positive association. [2],[3],[4],[6],[12],[13],[14] A plausible explanation for an association between baldness and CHD may be elevated androgen levels. [15],[16],[17] Men with severe baldness seem to have a greater number of androgen receptors in the scalp [18] and higher levels of both serum total and free testosterone. [19] One alternative possible link between MPB and CHD could be a similar pattern of inheritance, as others have speculated. [20] In our study, we have got statistically significant association of AGA in young Asian Gujarati male with CAD and the incidence of AGA in young (<45 years) CAD patient is 37.73%. And also significant association has been found between vertex baldness (Grades IV-VII) and CAD in young male population. Although early vertex baldness may be a nonmodifiable risk factor for CHD, it may serve as a useful clinical marker to identify men at increased risk, who may benefit from aggressive screening and primary prevention efforts directed toward other known modifiable risk factors for CHD.
| Conclusion | | |
In summary, however, our study provides support for the hypothesis that vertex pattern baldness is a marker for increased risk of CHD events. Further research is needed to corroborate these findings and to clarify the biological mechanisms that may explain this relationship.
| References | | |
| 1. | Lotufo PA, Chae CU, Ajani UA, Hennekens CH, Manson JE. Male pattern baldness and coronary heart disease: The Physicians' Health Study. Arch Intern Med 2000;160:165-71. 
|
| 2. | Lesko SM, Rosenberg L, Shapiro S. A case-control study of baldness in relation to myocardial infarction in men. JAMA 1993;269:998-1003.
|
| 3. | Schnohr P, Lange P, Nyboe J, Appleyard M, Jensen G. Gray hair, baldness, and wrinkles in relation to myocardial infarction: The Copenhagen city heart study. Am Heart J 1995;130:1003-10.
|
| 4. | Ford ES, Freedman DS, Byers T. Baldness and ischemic heart disease in a national sample of men. Am J Epidemiol 1996;143:651-7.
|
| 5. | Matilainen VA, Mäkinen PK, Keinänen-Kiukaanniemi SM. Early onset of androgenetic alopecia associated with early severe coronary heart disease: A population-based, case-control study. J Cardiovasc Risk 2001;8:147-51.
|
| 6. | Cotton SG, Nixon JM, Carpenter RG, Evans DW. Factors discriminating men with coronary heart disease from healthy controls. Br Heart J 1972;34:458-64.
[PUBMED] |
| 7. | Chumlea WC, Rhodes T, Girman CJ, Johnson-Levonas A, Lilly FR, Wu R, et al. Family history and risk of hair loss. Dermatology 2004;209:33-9.
|
| 8. | Rebora A. Baldness and coronary artery disease: The dermatologic point of view of a controversial issue. Arch Dermatol 2001;137:943-7.
[PUBMED] |
| 9. | Shahar E, Heiss G, Rosamond WD, Szklo M. Baldness and myocardial infarction in men: The atherosclerosis risk in communities study. Am J Epidemiol 2008;167:676-83.
|
| 10. | Ellis JA, Stebbing M, Harrap SB. Male pattern baldness is not associated with established cardiovascular risk factors in the general population. Clin Sci (Lond) 2001;100:401-4.
|
| 11. | Norwood OT. Male pattern baldness: Classification and incidence. South Med J 1975;68:1359-65.
[PUBMED] |
| 12. | Mirić D, Fabijanić D, Giunio L, Eterović D, Culić V, Bozić I, et al. Dermatological indicators of coronary risk: A case-control study. Int J Cardiol 1998;67:251-5.
|
| 13. | Cooke NT. Male pattern alopecia and coronary artery disease in men. Br J Dermatol 1979;101:455-8.
[PUBMED] |
| 14. | Mansouri P, Mortazavi M, Eslami M, Mazinani M. Androgenetic alopecia and coronary artery disease in women. Dermatol Online J 2005;11:2.
|
| 15. | Ellis JA, Sinclair R, Harrap SB. Androgenetic alopecia: Pathogenesis and potential for therapy. Expert Rev Mol Med 2002;4:1-11.
|
| 16. | Setty LR. Hair patterns of scalp of white and Negro males. Am J Phys Anthropol 1970;33:49-55.
[PUBMED] |
| 17. | Halim MM, Meyrick G, Jeans WD, Murphy D, Burton JL. Myocardial infarction, androgen and the skin. Br J Dermatol 1978;98:63-8.
[PUBMED] |
| 18. | Hibberts NA, Howell AE, Randall VA. Balding hair follicle dermal papilla cells contain higher levels of androgen receptors than those from non-balding scalp. J Endocrinol 1998;156:59-65.
|
| 19. | Demark-Wahnefried W, Lesko SM, Conaway MR, Robertson CN, Clark RV, Lobaugh B, et al. Serum androgens: Associations with prostate cancer risk and hair patterning. J Androl 1997;18:495-500.
[PUBMED] |
| 20. | Sheikh K. Re: "Baldness and ischemic heart disease in a national sample of men". Am J Epidemiol 1997;145:670-1.
[PUBMED] |
[Table 1], [Table 2], [Table 3], [Table 4]
| This article has been cited by | | 1 |
MTHFR C677T Polymorphism and Serum Homocysteine Level as Risk Factors of Coronary Heart Disease in Patients with Androgenetic Alopecia: A Case Control Study |
|
| Fawzia A Saafan, Ayman Z. Elsamanoudy, Dalia Shaalan, Nanees Zeidan, Mohammad A. Gaballah | | The American Journal of the Medical Sciences. 2021; 362(4): 375 | | [Pubmed] | [DOI] | | | 2 |
Clinical Patterns of Hair Loss in Men |
|
| Natalie Kash, Matt Leavitt, Adam Leavitt, Spencer D. Hawkins, Rahil B. Roopani | | Dermatologic Clinics. 2021; 39(3): 361 | | [Pubmed] | [DOI] | | | 3 |
A study on relationship between androgenetic alopecia and cardiovascular risk using high sensitivity C-reactive protein and galectin-3 in men with early onset baldness |
|
| Mehmet Sözen, Süleyman Baldane, Sedat Abusoglu, Levent Kebapcilar, Aysegül Kebapcilar, Fatma Tunçez Akyürek, Ali Ünlü, Süleyman Hilmi Ipekci | | Biomarkers. 2021; : 1 | | [Pubmed] | [DOI] | | | 4 |
Association Between Androgenic Alopecia and Coronary Artery Disease: A Cross-Sectional Study of Han Chinese Male Population |
|
| Ya-Xin Wang, Xiao-Wen Chen, Si-Bo Wang, Ling-Feng Gu, Ya-Fei Li, Yao Ma, Hao Wang, Lian-Sheng Wang | | International Journal of General Medicine. 2021; Volume 14: 4809 | | [Pubmed] | [DOI] | | | 5 |
CORRELATION BETWEEN ANDROGENIC ALOPECIAAND CORONARY ARTERY DISEASE SEVERITY ON CORONARY ANGIOGRAPHY AMONG YOUNG MALES IN CENTRAL INDIA |
|
| Amit Bhanudas Kinare, Pradeep Kumar Jain, Nimish Rai, Vishwa Deepak Tripathi | | INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH. 2020; : 15 | | [Pubmed] | [DOI] | | | 6 |
Pathomechanisms of immune-mediated alopecia |
|
| Alessandra Anzai, Eddy Hsi Chun Wang, Eunice Y Lee, Valeria Aoki, Angela M Christiano | | International Immunology. 2019; 31(7): 439 | | [Pubmed] | [DOI] | | | 7 |
Glycolipid and Hormonal Profiles in Young Men with Early-Onset Androgenetic Alopecia: A meta-analysis |
|
| Rossella Cannarella, Sandro La Vignera, Rosita A. Condorelli, Aldo E. Calogero | | Scientific Reports. 2017; 7(1) | | [Pubmed] | [DOI] | | | 8 |
Male baldness; association with coronary artery disease? |
|
| E.E. van der Wall | | Netherlands Heart Journal. 2015; 23(5): 263 | | [Pubmed] | [DOI] | | | 9 |
Association of male pattern baldness with angiographic coronary artery disease severity and collateral development |
|
| I. Sari,K. Aykent,V. Davutoglu,M. Yuce,O. Ozer,M. Kaplan,H. Alici,S. Ercan,M. Sunbul,K. Tigen | | Netherlands Heart Journal. 2015; 23(5): 265 | | [Pubmed] | [DOI] | |
|
 |
|
|
|
