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• Male Pattern baldness and its association with coronary heart disease: a meta-analysis: letter to the editor
  Pooja Arora
  Published on: 23 November 2015
• Androgens and the association of male pattern baldness with coronary heart disease
  C. Mary Schooling
  Published on: 23 November 2015

• Published on: 23 November 2015

  Male Pattern baldness and its association with coronary heart disease: a meta-analysis: letter to the editor

  • Pooja Arora, Assistant Professor
  • Other Contributors:
    • Shridhar Dwivedi

  Editor, The meta-analysis conducted by Yamada et al (2013) has established the association between baldness and coronary heart disease (CHD). The authors have concluded that vertex baldness among young men is closely related to atherosclerosis. Another factor that deserves mention in this context is smoking. We have many a times come across patients with severe arterial disease who have baldness and gray hair and on histo...

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  Editor, The meta-analysis conducted by Yamada et al (2013) has established the association between baldness and coronary heart disease (CHD). The authors have concluded that vertex baldness among young men is closely related to atherosclerosis. Another factor that deserves mention in this context is smoking. We have many a times come across patients with severe arterial disease who have baldness and gray hair and on history are found to be smokers or tobacco users, a practice very common in Indian subcontinent.1, 2 Several studies have analyzed the association between smoking and androgenetic alopecia (AGA) and the results are found to be conflicting. Su et al (2007) carried out a community based survey in Asian men to evaluate the association of AGA with smoking and found a positive association.3 Smoking status, current amount of cigarette smoking, and smoking intensity were statistically significant factors responsible for AGA. Similar results were found in a cross sectional survey conducted by Mosley and Gibbs.4 Smoking causes hair loss by several mechanisms. Genotoxicants in smoke affect the microvasculature as well as DNA of the dermal hair papilla. Smoking induces oxidative stress that leads to release of proinflammatory cytokines which, in turn, cause inflammation and fibrosis of hair follicle. Smoking also causes hydroxylation of estradiol thereby inducing a relative hypoestrogenic state.5 Mosley and Gibbs also found a significant relation between gray hair and smoking. The relation was consistent for all age groups in both sexes. One hypothesis proposed for this could be that smoking causes severe disease, which in turn causes biological aging and hence the graying of hair. The authors however did not study the dose-response relation. In another study by Kocaman SA et al, 213 men with suspicion of coronary artery disease (CAD) were evaluated in terms of age, demographical properties and CVRFs (cardiovascular risk factors).6 They found that the degree of gray/white hairs is related to extent of CAD. The authors also suggested that hair graying is a risk factor for CAD independent of age and other risk factors. These studies indicate the need for evaluation of cardiovascular risk factors, particularly smoking and tobacco habits, in younger men with vertex baldness, and men and women with premature graying. Such patients should be encouraged to quit tobacco chewing/smoking to improve their cardiovascular health. The potential relationship between smoking and premature graying and baldness should be further investigated and proper screening test designed to detect patients with asymptomatic CAD. References 1. Dwivedi S, Jhamb R. Cutaneous markers of cutaneous artery disease. World J Cardiol 2010; 2(9):1-8. 2. Dwivedi G, Dwivedi S. Betel quid seller syndrome. Occup Environ Med 2010; 67:144. 3. Su LH, Chen TH. Association of androgenetic alopecia with smoking and its prevalence among Asian men: a community-based survey. Arch Dermatol. 2007 Nov; 143(11):1401-6. 4. Mosley JG, Gibbs AC. Premature grey hair and hair loss among smokers: a new opportunity for health education? BMJ. 1996; 313(7072):1616. 5. Tru?eb RM. Molecular mechanisms of androgenetic alopecia. Exp Gerontol. 2002; 37(8-9):981-990. 6. Kocaman SA, ?etin M, Durako?lugil ME, Erdo?an T, ?anga A, ?i?ek Y et al. The degree of premature hair graying as an independent risk marker for coronary artery disease: a predictor of biological age rather than chronological age. Anadolu Kardiyol Derg. 2012 Sep; 12(6):457-63.

  Conflict of Interest:

  no competing interest/no conflict of interest

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  Conflict of Interest:
  None declared.

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• Published on: 23 November 2015

  Androgens and the association of male pattern baldness with coronary heart disease

  • C. Mary Schooling, Associate Professor

  Yamada et al. present a fascinating meta-analysis showing that male pattern baldness is associated with coronary heart disease (CHD).1 Although the association is subject to the inevitable limitations of observational studies, it is an intriguing observation for which Yamada et al. provide several potential mechanisms, such as classical coronary risk factors, hyperinsulinaemia or chronic inflammation causing both baldness...

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  Yamada et al. present a fascinating meta-analysis showing that male pattern baldness is associated with coronary heart disease (CHD).1 Although the association is subject to the inevitable limitations of observational studies, it is an intriguing observation for which Yamada et al. provide several potential mechanisms, such as classical coronary risk factors, hyperinsulinaemia or chronic inflammation causing both baldness and CHD, or perhaps baldness being caused by peripheral sensitivity to androgens.1 However, Yamada et al. do not explicitly consider the simplest mechanism, i.e., that the prime cause of male pattern baldness, androgens, also causes CHD. Although, androgens are generally seen as cardioprotective,2 no randomized controlled trial has ever shown that androgens reduce CHD events or mortality. Conversely, randomized controlled trials of testosterone have been stopped because of adverse, often cardiovascular, events amongst men given testosterone compared to placebo.3, 4 Notably, it has also recently come to light that one of the most effective treatments for CHD, i.e., statins, reduces testosterone.5 Given, it has been definitively demonstrated that lower estrogens among men than women does not explain the substantially higher rate of CHD among men than women, perhaps this study might give impetus to consideration of the alternative hypothesis that higher androgens among men than women is the explanation, with corresponding implications for the prevention and treatment of CHD.

  Reference List

  (1) Yamada T, Hara K, Umematsu H, Kadowaki T. Male pattern baldness and its association with coronary heart disease: a meta-analysis. BMJ Open 2013;3.

  (2) Kelly DM, Jones TH. Testosterone: a vascular hormone in health and disease. J Endocrinol 2013.

  (3) Testosterone treatment of men with alcoholic cirrhosis: a double -blind study. The Copenhagen Study Group for Liver Diseases. Hepatology 1986;6:807-13.

  (4) Basaria S, Coviello AD, Travison TG, Storer TW, Farwell WR, Jette AM, Eder R, Tennstedt S, Ulloor J, Zhang A, Choong K, Lakshman KM, Mazer NA, Miciek R, Krasnoff J, Elmi A, Knapp PE, Brooks B, Appleman E, Aggarwal S, Bhasin G, Hede-Brierley L, Bhatia A, Collins L, LeBrasseur N, Fiore LD, Bhasin S. Adverse events associated with testosterone administration. N Engl J Med 2010;363:109-22.

  (5) Schooling CM, Au Yeung SL, Freeman G, Cowling BJ. The effect of statins on testosterone in men and women, a systematic review and meta- analysis of randomized controlled trials. BMC Med 2013;11:57.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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