Associaton of Insulin Resistance Linked Diseases and Hair Loss in Elderly Men. Finnish Population-based Study

Abstract

Previous investigations have shown an association of androgenetic alopecia (AGA) with insulin resistance related disorders such as ischemic heart disease. An association between AGA and anthropometric abnormalities linked with insulin resistance and heredity in women aged 63 years has also been shown. We therefore compared 63-year-old men with AGA and ones with normal hair status for insulin resistance linked parameters. A population of 245 men aged 63 years, who were participants in a population-based cross-sectional study in the City of Oulu, underwent a medical check-up including assessment of hair status on the Hamilton-Norwood scale and determination of anthropometric measures, blood pressure, fasting glucose and serum lipids. Fifty eight per cent of the men reported extensive hair loss (grade III-VII). Hypertension and the use of antihypertensive drugs were common among men with AGA (61% vs. 45% and 50% vs. 26%, respectively). The rates of diabetes and hyperinsulinemia (21% vs. 12% and 61% vs. 49%) were higher among men with AGA compared to those with normal hair status but no difference was seen in other factors. Our findings show that AGA is common among Finnish men aged 63 years but that it is also associated with insulin linked disturbances, such as hypertension and diabetes. Such men developing AGA might benefit from attention in medical check-up.

Full text

Cent Eur J Publ Health 2006; 14 (2): 78–81
ASSOCIATION OF INSULIN RESISTANCE LINKED
DISEASES AND HAIR LOSS IN ELDERLY MEN.
FINNISH POPULATION-BASED STUDY
Päivi Hirsso
1
, Mauri Laakso
1, 2
, Veikko Matilainen¹, Liisa Hiltunen
1, 2, 3
, Ulla Rajala ¹, Jari Jokelainen
1, 2
,
Sirkka Keinänen-Kiukaanniemi
1, 3
1
University of Oulu, Department of Public Health Science and General Practice, University of Oulu, Finland
2
Unit of General Practice, Oulu University Hospital, Finland
3
Oulu Health Center, City of Oulu, Finland
SUMMARY
Previous investigations have shown an association of androgenetic alopecia (AGA) with insulin resistance related disorders such as ischemic
heart disease.An associationbetweenAGAand anthropometric abnormalities linked with insulin resistance and heredity in women aged63 years has
also been shown. We therefore compared 63-year-old men with AGA and ones with normal hair status for insulin resistance linked parameters.
A population of 245 men aged 63 years, who were participants in a population-based cross-sectional study in the City of Oulu, underwent
a medical check-up including assessment of hair status on the Hamilton-Norwood scale and determination of anthropometric measures, blood
pressure, fasting glucose and serum lipids.
Fifty eight per cent of the men reported extensive hair loss (grade III-VII). Hypertension and the use of antihypertensive drugs were common
among men with AGA (61% vs. 45% and 50% vs. 26%, respectively). The rates of diabetes and hyperinsulinemia (21% vs. 12% and 61% vs. 49%)
were higher among men with AGA compared to those with normal hair status but no difference was seen in other factors.
Our ndings show that AGA is common among Finnish men aged 63 years but that it is also associated with insulin linked disturbances, such
as hypertension and diabetes. Such men developing AGA might benet from attention in medical check-up.
Key words: androgenetic alopecia, hair loss, insulin resistance
Address for correspondence: P. Hirsso, BOX 5000, Department of Public Health Science and General Practice, University of Oulu, FIN-900014
University of Oulu, Finland. E-mail: paivi.hirsso@oulu.
INTRODUCTION
An association between androgenetic alopecia (AGA)
and cardiovascular events such as myocardial infarction and
ischemic heart disease has been previously reported (1–5).
Finnish case-control studies have suggested an increased risk of
hyperinsulinaemia and insulin resistance related disorders such
as hypertension and dyslipidaemia and of severe coronary heart
disease among men with early onset AGA compared to men with
normal hair status (6–7). Associations between female AGA
(grade II or III on Ludwig`s scale) among 63-year-old women
and some markers of insulin resistance, android-type obesity and
heredity have been reported recently (8). The aim of the present
study was to test the association of male-pattern AGA in men
aged 63 with insulin resistance-linked disorders.
SUBJECTS AND METHODS
This study was a population-based cross-sectional study. All
the participants (n=831) of a previous population-based follow-
up study carried out in 1990–1992 (9) in the City of Oulu were
invited to participate in this study in 1996–1998, and 593 of them
participated (245 men). Questionnaires, interviews, clinical exa-
minations and laboratory tests were used to collect data during the
follow-up period in 1996–1998. The material and methods have
been described in more detail in previous publications (8,10).
The hair status of 221 men was assessed by a trained nurse
as part of the clinical examination using the Hamilton-Norwood
scale (11). The original classes I–II were merged form to larger
categories: normal hair/mild alopecia (classes I–IIIb) and exten-
sive hair loss (classes IIIvertex–VII). Additional questions asked
about the most plentiful hair loss if any significant had existed
and the family history of hair loss also.
The potential insulin resistance linked factors; body mass
index (BMI, weight in kilograms divided by the square of height
in meters), neck/hip and waist circumference, and systolic and
diastolic blood pressure were measured. Height and weight in
light clothing for calculating BMI were measured in the clinical
examination. Two measurements of blood pressure (BP) were
made by the physician from both arms in sitting and recumbent
positions. The mean value of these four measurements was used
in analyses. Hypertension was defined as either a systolic blood
pressure ≥160 mmHg or a diastolic blood pressure ≥ 90 mmHg
or being on antihypertensive medication regardless of the blood
pressure values. Drug treatment for hypertension was recorded
in an interview conducted by a physician. In addition to this, the
postal questionnaire included the following questions: “Do you
78

have diabetes mellitus/hypertension diagnosed by a physician?”
and “Do you use any antidiabetic medication?” Smoking habits
were asked in the postal questionnaire.
The following biochemical data concerning the traditional
cardiovascular risk factors were recorded: fasting total cholesterol
(chol), high-density lipoprotein (HDL)-cholesterol, triglyceride
(TG) and insulin concentrations as well as fasting and two-hour
glucose concentrations after a 75 g glucose load measured from
a blood-sample taken after an overnight (10 h) fast.A standardized
75 g oral glucose tolerance test (OGTT) was performed according
to the instructions of the WHO Study Group (12). Subjects with
impaired glucose tolerance and normal glucose tolerance were
combined as non-diabetic subjects. Serum immunoreactive insulin
concentrations were measured by RIA using the Phadeseph Insu-
lin RIA 100 kit (Pharmacia Diagnostics AB, Uppsala, Sweden),
which also detects proinsulin and proinsulin conversion products
with considerable sensitivity. The cross-reactivity of proinsulin
in this assay is about 41%. Insulin levels were not analysed from
the samples of the diabetic patients with insulin treatment. Urine
albumin and creatine concentrations were measured from an
overnight spot urine sample. The highest decile of the urinary
albumin to creatine ratio (≥2.5 mg/mmol) was used as a measure
of microalbuminuria. To measure insulin sensitivity, an insulin
sensitivity check index (Quicki) was used (13–14). The deter-
minations mentioned above were made in the laboratory with
a standardized quality control system.
Table 1. Means/medians and standard deviations (SD) /
interquartile range of background characteristics among men
aged 63 years with extensive hair loss and normal hair
Extensive hair loss
n=128
Normal hair
n=92
Mean
Sd Mean Sd
Weight (kg) 82.9 12.6 85.5 12.6
Length (cm)* 173.0 5.6 174.6 6.3
BMI (kg/m
2
) 27.6 3.6 27.9 3.7
Neck circ. (cm) 40.7 2.6 41.1 2.6
Hip circ. (cm) 101.4 7.1 102.4 7.2
Waist circ. (cm) 95.8 10.7 97.3 9.9
WHR 0.94 0.06 0.95 0.05
SBP (mmHg) 142.8 18.5 141.9 18.3
DBP (mmHg) 79.3 8.0 79.4 6.9
Fs-chol (mmol/l) 5.7 0.9 5.6 0.8
HDL-chol
(mmol/l)
1.3 0.3 1.3 0.3
2-h gluc
(mmol/l)
6.9 2.2 6.8 2.1
Median Q1-Q3 Median Q1-Q3
Fs-trigly
(mmol/l)
1.3 0.9–1.7 1.2 0.9–1.8
Fb-gluk (mmol/l) 4.9 4.6–5.6 5.0 4.8–5.5
Fs-ins (mU/l) 10.0 8.0–15.0 9.0 8.0–14.0
U-alb/krea ratio 0.92 0.68–1.18 0.91 0.71–1.54
Insulin sensitivity
(Quicki)
0.33 0.32–0.35 0.34 0.32–0.35
*p = 0.021 (t-test)
79
Statistical Analyses
The summary statistics for normally distributed continuous
variables were expressed as mean and standard deviation and as
median with interquartile range (25th and 75th percentiles) for
non-normally distributed variables. The statistical differences
between the continuous variables were tested by the t-test when
the distribution was normal and with the Mann-Whitney U-test in
a non-normal situation. For categorical variables, the χ
2
test was
used to calculate the unadjusted odds rations (OR) and their 95%
confidence intervals (CI) for each dichotomized variable. On the
basis of bivariate logistic regression analysis, adjustments were
performed only for the potential risk factors that were significantly
associated with hair loss. Statistical analyses were performed
using SPSS for Windows (version 10.0)
RESULTS
The prevalence of extensive hair loss was 58.4% among these
63-year-old men. Twenty-two per cent of the men with extensive
hairlossreported theonsetofabundanthairlossatanageyounger
than 35 years. The means or medians of the continuous variables
relative to hair status are presented in Table 1. The men with
extensive hair loss were shorter (173 cm vs. 175 cm, p = 0.021)
but their body weight was lower compared to those with normal
hair status, while no difference in BMI or the other biochemical
markers of insulin resistance was seen.
The absolute numbers and percentages of insulin resistance
associated states, such as diabetes, dyslipidemia and hypertension
as well as hyperinsulinemia and microalbuminuria, smoking status
and the presence of maternal or paternal hair loss in the subgroups
of hair status classes are presented in Table 2. Adjustment for
hyperinsulinemia, hypertension, diabetes and paternal heredity
did not alter these associations (Table 3). The use of antihyper-
tensive medication was clearly more frequent among the men
with extensive hair loss (50% vs. 26%, p = 0.0003) and those
with extensive hair loss used more frequently β-channel blockers
(30% vs. 15%, p=0.010) and angiotensin-converting enzyme
Table 2. Percentages of insulin resistance associated disease,
hyperinsulinemia, microalbuminuria, smoking and heredity
among men aged 63 years with extensive hair loss and nor-
mal hair
Extensive hair loss
n=129
Normal hair
n=92
n % n % p
Hyperinsulinemia
1)
78 61 44 49 0.078
Diabetes
2)
27 21 11 12 0.081
Dyslipidemia
3)
45 35 34 37 ns.
Hypertension
4)
77 62 41 45 0.016
Microalbuminuria
5)
11 9 7 8 ns.
Paternal heridity 57 47 21 23 0.0003
Maternal heredity 3 3 1 1 ns.
Smoking 25 19 19 21 ns.
1)
Hyperinsulinemia: fs-insulin ≥10U/l.
2)
Diabetes: according to WHO 1997 criteria
or antidiabetic drugs.
3)
Dyslipidemia: hypertriglyceridemia ≥1.7 mmol/l, HDL-chol
<1.0 mmol/l or lipid-lowering agents.
4)
Hypertension: systolic blood pressure
≥160 mmHg or diastolic blood pressure ≥90 mmHg or antihypertensive drugs.
5)
Microalbuminuria: urinary albumin-to-serum creatinine ratio ≥2.5

Table 3. Odds ratios (OR) and 95 % condence intervals (95%
CI) of extensive hair loss associated with hyperinsulinemia,
diabetes, hypertension and paternal heredity in men
Unadjusted Adjusted
OR
95% CI OR 95% CI
Hyperinsulinemia
1)
1.63 0.95-2.81 1.56 0.85-5.53
Diabetes
2)
1.96 0.92-4.20 1.94 0.82-4.59
Hypertension
3)
1.96 1.13-3.38 1.81 0.97-3.37
Paternal heredity 3.01 1.65-5.51 2.71 1.44-5.13
1)
Hyperinsulinemia: fs-insulin ≥10U/l
2)
Diabetes: according to WHO 1997 criteria or antidiabetic drugs.
3)
Hypertension: systolic blood pressure ≥160 mmHg or diastolic blood pressure
≥90 mmHg or antihypertensive drugs
inhibitors (ACE) (17% vs. 7%, p=0.020) compared to the men
with normal hair status.
DISCUSSION
This population-based study revealed an association of AGA
with insulin resistance linked diseases among men aged 63 years,
but associations between AGA and markers of insulin resistance
were rare. Previous investigations have suggested a link between
AGA and elevated BMI in older men (1, 6–7), but some studies
have given negative results (5, 15–17). In one population-based
study (15) the preliminary association between AGA and cardio-
vascular risk factors disappeared after adjustment for age. In that
study, the final classification of AGA was based on self-reported
hair status and the age distribution of study population differs from
those used in our study of 63 years old men. Lotufo et al. (5) and
Trevisan et al. (17), who focused on selected populations, found
higher BP and higher concentration of serum cholesterol among
men with AGA. A Finnish case-control study suggests that AGA
is not associated only with cardiovascular risk factors (6) but also
with severe coronary heart disease (7).
In this study, the prevalence of hair loss was 58% among
northern Finnish men aged 63 years. The prevalence of male-
pattern hair loss is known to increase with age. For example, the
occurrence of extensive hair loss has been reported to be 40% in
subjects aged 40–49 years, 50% in subjects aged 50–59 years,
and 60% in subjects aged 60–69 years (11). In the Framingham
study hair loss in men aged 55–64 years amounted to 68% (3),
which results are in accordance with our findings. The recent
studies from Australia (16) and Singapore (18) both reported
higher prevalence of AGA in men of this age. There are ethnic
differences in the study populations and the classification ofAGA
had been modified by authors. In a Korean study, the prevalence
of AGA in men aged 60–69 years was 34% (19) which is lower
than among Caucasian men.
As previously reported in women in our study (8), paternal
heredity was also associated with AGA in men. The association
was stronger than earlier reported in Korean men (19) and as we
know, the heritability and genetic background of hair loss have
been under consideration for decades (20). Hair loss in female
relatives was rarely reported, which could be partly due to the
difficulty to recognize female-type hair loss. The most intensive
hair loss starting at an age younger than 35 years in 22% of men
with hair loss was quite low. This might be due to the memory-
bias or misunderstanding of the question.
The strengths of our study include the population-based sample
and the standard classification scale used by trained nurses. The
Hamilton-Norwood scale is considered to be well reproducible
(4). One limitation is that we could not determine the effect of
antihypertensive drugs on AGA. According the previous studies,
antihypertensive drugs (α- and β-channel blockers, ACE, calcium
channel blockers) may induce hair loss (21–22) and, on the other
hand, men with extensive hair loss used more frequently β-channel
blockers or ACEs than men with normal hair.
To sum up, AGA seems to connect with insulin resistance
linked diseases in men at older age but not with the markers of
insulin resistance. It remains unclear whether insulin resistance
has led to development of the disease because of aging among
subjects withAGAor whether there are some connections between
the use of drugs andAGA. In a retrospective study of this kind, the
effects of drugs on hair status and the impacts of health education
given to balding men with diabetes and hypertension cannot be
excluded. The risk of AGA increases with age in general, and
regardless of diseases or medication, there is also a tendency to
hair loss in the healthy population and such men developing AGA
might benefit from attention in medical check-up.
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Received May 3, 2005
Accepted November 14, 2005
CANCER
WHAT IS CANCER?
Cont. from p. 73
o Up to one third of the cancer burden could be reduced by implement
-
ing cancer preventing strategies which are aimed at reducing the
exposure to cancer risk mainly by:
- changes in tobacco and alcohol use, and dietary and physical activity
patterns
- immunization against HPV infection
- the control of occupational hazards
- reducing exposure to sunlight
o Another third of the cancer burden could be cured if
detected early
and treated adequately.
Early detection of cancer is based on the observation that treatment
is more effective when cancer is detected earlier. The aim is to detect the
cancer when it is localized.
There are two components of early detection programmes for cancer:
- Education to promote early diagnosis by recognizing early signs
of cancer such as: lumps, sores, persistent indigestion, persistent
coughing, and bleeding from the body’s orifices; and the importance
of seeking prompt medical attention for these symptoms.
-
Screening is the identification by means of tests of people with
early cancer or pre-cancer before signs are detectable. Screening
tests are available for breast cancer (mammography) and cervical
cancer (cytology tests).
o
Treatment of cancer is aimed at curing,prolonginglifeandimprov-
ing quality of life of patients with cancer. Some of the most common
cancertypes such asbreast cancer,cervicalcancerandcolorectalcancer
have a high cure rate when detected early and treated according to best
evidence. The principal methods of treatment are surgery, radiotherapy
and chemotherapy. Fundamental for adequate treatment is an accurate
diagnosis by means of investigations involving imaging technology
(ultrasound, endoscopy, radiography) and laboratory (pathology).
o
Relief from pain and other problems can be achieved in over 90% of all
cancer patients by means of palliative care. Effective strategies exist
for the provision of palliative care services for cancer patients and their
families, even in low resource settings.
WHO‘S STRATEGY FOR PREVENTION AND CONTROL
OF CANCER
Following the adoption of a Cancer Prevention and Control Resolution
at the 58
th
WHA on May 2005, WHO is developing the Global WHO
Cancer Control Strategy. The Strategy aims at reducing the cancer
burden and cancer risk factors as well as improving the quality of life
of patients and their families worldwide by means of planning and im-
plementing cancer prevention and control strategies. The cancer control
strategy is integrated into the overall WHO chronic disease prevention
and control framework of the Department of Chronic Diseases and
Health Promotion. The cancer control strategy is based on the following
guiding principles:
o People-centered: the ultimate goal is to improve the well-being of
the people, communities, families and individuals.
o
Equity: the strategy focuses on the needs of low-and middle-income
countries and of vulnerable and marginalized populations.
o
Ownership: the strategy guarantees the strong commitment and active
involvement of key stakeholders in each stage of the decision-making
process and implementation.
o P
artnership and multisectoral approach: the strategy ensures
the wide participation and collaboration of all sectors: public and
private,
o
Sustainability: the strategy emphasizes the need for national gov-
ernments and partners collectively strive for financial and technical
self-reliance, to ensure the continuation of benefits from established
programmes after major assistance has been completed.
o
Integration: the strategy is embedded within the overall framework
ofchronicdiseasepreventionand controland otherrelatedareas(such
as environmental health, communicable diseases, etc).
o
Stepwise approach: the strategy considers the implementation of
interventions, at a national or sub-national level, in a sequential man
-
ner.
o
Evidence-based: the strategy is based on research results, programme
evaluation, economic analysis, best practice, and lessons from coun-
tries.
WHO, in cooperation with its cancer research agency, the International
Agency for Research in Cancer (IARC), and other organizations of the
United Nations system, will provide the leadership for international cancer
prevention and control and will develop the following actions:
o
Advocacy and political commitment for cancer prevention and control
o Generation of new knowledge and dissemination and diffusion of ex-
isting knowledge to facilitate the application and programme delivery
of evidence-based approaches to cancer control
o Development of standards and tools for guiding effective cancer
control planning and implementation of evidence-interventions for
prevention, early detection, treatment and palliative care
o Facilitating the development of multisectoral networks of cancer
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and programmes and strengthening health systems
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health policies and programmes in developing countries
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Fact Sheet N°297
February 2006
81