Baldness and Myocardial Infarction in Men: The Atherosclerosis Risk in Communities Study

Eyal Shahar; Gerardo Heiss; Wayne D. Rosamond; Moyses Szklo

Disclosures

Am J Epidemiol. 2008;167(6):676-683. 

In This Article

Abstract and Introduction

Because hair loss may be a surrogate measure of androgenic activity -- possibly a determinant of coronary atherosclerosis -- several studies have explored the presence and magnitude of an association between male pattern baldness and myocardial infarction (MI). In particular, vertex baldness, but not frontal baldness alone, was strongly associated with incident MI in a large, hospital-based, case-control study. The authors examined these associations in a cross-sectional sample of 5,056 men aged 52-75 years, of whom 767 had a history of MI. The sample was derived from the Atherosclerosis Risk in Communities (ARIC) Study (1987-1998). As compared with a baldness-free reference group, the estimated odds ratios for prevalent MI from a multivariable model were 1.28 (frontal baldness), 1.02 (mild vertex baldness), 1.40 (moderate vertex baldness), and 1.18 (severe vertex baldness). Other regression models have yielded similar results, including the absence of a monotonic "dose-response relation" between the extent of vertex baldness and prevalent MI. The authors also examined the relation of baldness pattern to carotid intimal-medial thickness, a measure of atherosclerosis, among those who were free of clinical cardiovascular disease. The estimated mean differences in carotid intimal-medial thickness between groups of men with various types of baldness and their baldness-free counterparts were all close to zero. The results of this study suggest that male pattern baldness is not a surrogate measure of an important risk factor for myocardial infarction or asymptomatic atherosclerosis.

The possible relation between balding and coronary heart disease has attracted interest since the 1960s,[1] if not earlier. At least 10 studies have addressed the topic, some of which were pioneering, preliminary research, whereas others have met contemporary standards for epidemiologic studies.[1,2,3,4,5,6,7,8,9,10] Unfortunately, that small body of literature has generated inconsistent findings, and the titles of recent reviews reflect the controversy.[11,12] The following questions, in particular, await empirical answers: 1) Is any baldness, regardless of pattern, meaningfully associated with myocardial infarction (MI) or atherosclerotic burden? 2) Are frontal baldness and vertex baldness equivalent in that respect? 3) Does the extent of vertex baldness matter?

In 1993, Lesko et al.[5] published results from a large, hospital-based, case-control study of male pattern baldness and myocardial infraction. Vertex baldness, but not frontal baldness alone, was strongly associated with MI in a monotonic "dose-response" fashion: the greater the extent of vertex baldness, the greater the risk of MI. We attempted to replicate those findings in a cross-sectional sample, derived from a population-based cohort. We also extended the question to address the relation between baldness pattern and carotid intimal-medial thickness, a measure of the systemic burden of atherosclerosis.[13,14]

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