It appears that balding men have more to worry about than their vanity. The largest study to date concludes that male pattern baldness is associated with an increased risk for heart disease.
The more the hair loss, the higher the possible risk, according to researchers from the Harvard Medical School and Brigham and Womens Hospital in Boston. Age seems to make no difference.
The study covered the relationship between hair loss and heart conditions such as nonfatal heart attacks, angina or chest pains, and procedures to open blocked coronary arteries (angioplasty and bypass surgery).
Compared with men with no hair loss, risks for such events increased 9 percent in those starting to lose hair on the front of their heads. When a bald spot appears on the crown, relative risk jumps to 23 percent. When all hair is gone from the top of the head, the risk rises to a worrisome 36 percent.
” We found men with extensive baldness that involves the top of their heads have the greatest risk of heart disease,” says JoAnn Manson, professor of medicine at Harvard Medical School. “However, those with mild frontal hair loss, or a receding hair line, have no appreciable increase in risk.”
Comparative risk of heart disease increases from zero with no hair loss to 36 percent for severe crown baldness. As you might expect, the risks get worse in men with high blood pressure and high cholesterol. The combination of crown baldness and high blood pressure almost doubles the comparative risk. Men with extensive pattern baldness and high cholesterol are at nearly three times the risk of heart disease compared to those with high cholesterol and no hair loss.
This information comes from questionnaires first filled out by 22,071 physicians aged 40 to 84 years in 1982. Eleven years later, they completed a follow-up questionnaire about their pattern of hair loss at age 45. Both questionnaires also asked for information about heart disease, high blood pressure, and cholesterol levels.
The studys conclusion agrees with those of several other large surveys. For example, the First National Health and Nutrition Examination Study checked the degree of baldness in 3,942 men and found severe hair lose to be linked with heart-disease deaths among men younger than 55 years. The link did not hold for older males.
Hormones or Heredity?
What could cause such an association? The short answer is: the experts dont know. The long answer is: it might be due to excess testosterone, or to genes.
Men with severe baldness seem to have a larger number of male hormone receptors in their scalps than men with a complete head of hair. (Theres the old wives tale about bald men being more virile.) “Testosterone and its more active form, dihydrotestosterone, close off hair follicles and interfere with growth,” notes Manson. “These hormones also have been linked with high blood pressure, abnormal cholesterol, increased risk of thickening and hardening of arteries, and fatty deposits in these blood vessels. Testosterone is, in fact, one of the reasons men have a higher risk of heart disease than women.”
Manson points out that hair-restoring drugs like finasteride arrest hair loss in some men by blocking the action of testosterone. But such drugs work least well in the case of severe hair loss on the crown. Also, it is unknown if these drugs can lower the risk of heart disease.
Alternatively, the link could be inherited. Recent findings, the study report points out, suggest similarities between male pattern baldness and polycystic ovary syndrome, a condition in some women that is likely to increase the risk of hardening of arteries, of high levels of blood fats, and of low levels of good cholesterol. Brothers of such women have an increased likelihood of male pattern baldness.
The investigators admit that further research is needed to corroborate their conclusions and “to clarify the biological mechanisms that may explain the relationship between baldness and coronary heart disease.”
Although the causes of the increased risk remain unknown and nothing much can be done about male pattern baldness, the researchers believe their findings are immediately applicable. The hair loss, Manson says, “may serve as a marker to identify men who can benefit from vigilant screening and aggressive attention to factors known to reduce heart disease risk, such as lowering blood pressure and cholesterol, quitting smoking, and maintaining a healthy weight with diet and exercise.”
The full report appears in the January 24 issue of the Archives of Internal Medicine.