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

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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.
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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14. Hrebíček J, Janout V, Malinčíková J, Horáková D, Čížek L. Detection
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Endocrinol Metab. 2002 Jan;87(1):144–7.
15. 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 Apr;100(4):401–4.
16. Severi G, Sinclair R, Hopper JL, English DR, McCredie MR, Boyle P, et
al. Androgenetic alopecia in men aged 40-69 years: prevalence and risk
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17. Trevisan M, Farinaro E, Krogh V, Jossa F, Giumetti D, Fusco G, et al.
Baldness and coronary heart disease risk factors. J Clin Epidemiol. 1993
Oct;46(10):1213–8.
18. Tang PH, Chia HP, Cheong LL, Koh D. A community study of male
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May;41(5):202–5.
19. Paik JH, Yoon JB, Sim WY, Kim BS, Kim NI. The prevalence and types
of androgenetic alopecia in Korean men and women. Br J Dermatol. 2001
Jul;145(1):95–9.
20. Kuster W, Happle R. The inheritance of common baldness: two B or not
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Fairfield: Canfield Publishing; 1998.
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
control partners at the global, regional and national levels
o Building capacity for developing and implementing effective policies
and programmes and strengthening health systems
o Provision of technical assistance for the rapid, effective and efficient
translation of evidence-based cancer control interventions into public
health policies and programmes in developing countries
For more information contact:
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Fact Sheet N°297
February 2006
81
... According to this, lower SHBG levels may be regarded as a risk factor for the development of hyperglycaemia, insulinresistance, and/or DM II in young patients with AGA. However, among metabolic abnormalities, a higher prevalence of hyperinsulinemia, hypertriglyceridemia, and hypertension has been reported in siblings with PCOS; more specifically they seem to occur frequently in brothers of women with PCOS (11,15,16). ...
... In accordance with the last concept, an increased prevalence of metabolic disorders, such as insulin resistance (IR) and obesity, as well as, the early-onset AGA has been reported in first degree of male and female relatives of women with PCOS. Moreover, scientific evidence reported that men with the early-onset AGA and higher body mass index (BMI) have higher risk of developing hyperinsulinemia (11)(12)(13). Finally, in contrast with the expectations, the association among higher BMI values, insulin resistance, and higher blood pressure is still controversial (17). ...
... Similarly, first degree relatives of women with PCOS report an increased prevalence of insulin resistance, obesity, and early-onset AGA. Moreover, although the association with male equivalent PCOS and hyperinsulinemia is still controversial, several studies demonstrated that men with the early-onset AGA and higher BMI had higher risk of developing insulin resistance (11)(12)(13). ...
Article
Full-text available
Recent studies identified the presence of a male polycystic ovarian syndrome (PCOS), which mainly affects men whose female relatives are afflicted with PCOS, caused by genes responsible for the susceptibility of this syndrome in women. Similar hormonal, metabolic, and clinical alterations occurring in PCOS women have also been reported in their male relatives, suggesting a association between the male and female forms of the syndrome. Although the remarkable clinical manifestation of the male equivalent PCOS is diagnosed by the early-onset androgenetic alopecia, character-ized by hair recession, pronounced hypertrichosis, insulin resistance, biochemical and hormonal abnormalities, the hormonal/metabolic profile is still controversial. Men affected by early-onset androgenetic alopecia (AGA) are at risk of developing hyperinsulinemia, insulin-resistance, dyslipidaemia, and cardiovascular diseases. However, there is no consensus on the association of male equivalent PCOS with hypertension and obesity. Moreover, reduced levels of sex hormone-binding globulin have been detected in these male patients, accompanied by increased free androgens. Conversely, literature reported lower concentrations of testosterone in male equivalent PCOS when compared with the normal range, indicating a crucial role for the conversion of cortical androgens. Finally, further studies are warranted to investigate a possible link among AGA, metabolic/hormonal alterations, and acne. Our study assessed the hormo-nal, metabolic and clinical aspects of male equivalent PCOS syndrome reported in the literature to evaluate similar and divergent elements involved in the female version of the syndrome.
... Mean blood pressure measurements were higher in male patients with AGA compared to the controls. Some reports have indicated an HT prevalence of 65-85% in men with AGA (Hirsso et al. 2006, Ahouansou et al. 2007. Although the relationship between AGA and HT has not been fully explained, two possible mechanisms are as follows: (1) elevation of blood pressure via binding of increased androgens to mineralocorticoid receptors in AGA and (2) direct contribution of hyperaldosteronism observed in HT to the development of alopecia via interaction with overexpressed mineralocorticoid receptors in the skin (Marie et al. 2007). ...
... In a study conducted on the Finnish population, higher rates of hyperinsulinaemia were shown in patients with early-onset AGA; however the mechanism of action could not be clarified (Hirsso et al. 2006). In our study population, the insulin rates were similar to the control group (p ¼ 0.308). ...
Article
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Objective In this study, the objective was to evaluate the cardiovascular and metabolic effects in men with male pattern alopecia beginning before 30 years of age. Methods Total of 81 people (41 androgenetic alopecia (AGA) and 40 healthy individuals), were included in the study. 24-hour ambulatory blood pressure (ABP) measurement, high sensitive C-reactive protein (hsCRP), galectin-3 were studied. Hamilton-Norwood scale (HNS) was used to determine the AGA types of the cases. Results The mean age in the AGA and control groups was 30.3 ± 7.5 and 30.8 ± 6.0, respectively. 24-hour ABP measurements, hsCRP, and galectin-3 were similar in both groups. There was a positive correlation between HNS grade with age, BMI, triglyceride levels and fasting blood glucose levels in individuals with AGA. Similarly, there was a positive correlation between HNS grade with daytime pulse wave velocity and night-time reflection magnitude. A significant positive correlation was determined between hsCRP with BMI and waist circumference, and between galectin-3 with BMI, waist circumference, hip circumference, HOMA-IR in individuals with AGA. Conclusions This study shows that AGA patients are similar to the normal population in terms of insulin resistance or metabolic syndrome components. However, hsCRP and galectin-3 appear to be associated with cardiovascular disease risk factors in individuals with AGA.
... Many studies have shown that AGA is also involved in the development of CVD risk factors. 2,12,[36][37][38] It has been revealed that AGA patients have higher levels of blood pressure, LDL-C, TC, and TG. 36 And AGA patients have a higher risk of metabolic syndrome. ...
... 38 Hirsso et al conducted a cross-sectional study showing that AGA might be positively correlated with hypertension. 37 The increase of serum aldosterone, which is an important cause of hypertension, may directly affect the development of AGA. 2 Insulin resistance, another CVD risk factor, has been reported to affect the blood supply to the scalp, resulting in impaired nutrient supply to the hair follicles. 12 Moreover, insulin resistance may increase free androgen levels by inhibiting SHBG (sex hormone binding globulin), ultimately leading to hair loss. ...
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Purpose: This research aimed to investigate the correlation between androgenic alopecia (AGA) and coronary artery disease (CAD) and analyze its value in predicting the severity of coronary atherosclerosis in the Han Chinese male population. Patients and methods: A total of 402 Han Chinese male patients aged 28-75 years were enrolled and performed coronary angiography (CAG) after admission. According to the BASP classification, the participants were divided into mild, moderate and severe AGA. CAD was determined via CAG and defined as stenosis of ≥50% in at least one major coronary artery, and the Gensini score was calculated to evaluate the severity of coronary atherosclerosis. Results: In this study, CAD status (P = 0.002), dyslipidemia status (P = 0.002), age (P = 0.003) and coronary atherosclerosis severity (P < 0.001) were different in patients with different levels of AGA. Multivariate logistic regression analysis revealed that severe AGA was independently correlated to CAD risk (OR, 2.111; 95% CI 1.152 to 3.870, P = 0.016), while the relative CAD risk of early-onset AGA was 2.292 (OR, 2.292; 95% CI 1.132 to 4.640, P = 0.021). AGA status (OR, 2.247; 95% CI 1.396 to 3.617, P = 0.001), severe AGA (OR, 2.360; 95% CI 1.506 to 3.699, P < 0.001) and early-onset AGA (OR, 3.474; 95% CI 2.069 to 5.832, P < 0.001) were all independently associated with the severity of coronary atherosclerosis. The area under the receiver operating characteristic (ROC) curve plotted using severe AGA was 0.601, which is predictive of severe coronary atherosclerosis. Moreover, the presence of severe AGA increases the risk of developing CAD associated with obesity (SI = 1.663, SIM = 1.222, AP = 0.289), diabetes (SI = 2.239, SIM = 1.149, AP = 0.503) and dyslipidemia (SI = 1.062, SIM = 0.646, AP = 0.045). Conclusion: This study suggested that AGA is independently associated with CAD in a Han Chinese male population. AGA may be a simple and feasible method for screening CAD and indicative of the severity of coronary atherosclerosis.
... Impaired insulin sensitivity was observed even after exclusion from the analysis of obese individuals [9]. Moreover, subjects with male-pattern hair loss were more frequently treated with anti-hypertensive agents than men with normal hair growth [18]. The mechanisms underlying the association between androgenic alopecia and metabolic syndrome have not been fully understood but seem complex. ...
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Background Early-onset androgenic alopecia is considered the phenotypic equivalent of polycystic ovary syndrome in men. The purpose of the current study was to investigate whether the presence of early-onset male-pattern baldness modulates metabolic effects of metformin. Methods This prospective case–control study included 2 groups of men at high risk for type 2 diabetes: 72 individuals with androgenic alopecia (group A) and 75 subjects with normal hair growth (group B). Both groups were matched for age, blood pressure, body mass index, insulin sensitivity and plasma lipids. Glycated hemoglobin, glucose, plasma lipids, indices of insulin sensitivity/resistance, sex hormones, high-sensitivity C-reactive protein (hsCRP) and 25-hydroxyvitamin D were determined before and after metformin treatment (1.7 g daily). Results Twelve-month metformin treatment reduced fat content, waist circumference, glycated hemoglobin, glucose and triglycerides, as well as improved insulin sensitivity. Although observed in both study populations, these effects were more pronounced in group B. Moreover, metformin decreased hsCRP and bioavailable testosterone levels in group B, as well as reduced 25-hydroxyvitamin D concentration in group A. Treatment-induced changes in glucose homeostasis markers correlated with the impact of metformin on hsCRP and 25-hydroxyvitamin D levels. Conclusions Metabolic effects of metformin in males are attenuated if they have coexisting early-onset androgenic alopecia. This finding may be partially explained by differences in severity of low-grade systemic inflammation and vitamin D status. The obtained results, requiring confirmation in large prospective studies, suggest that men with early-onset male-pattern baldness benefit to a lesser degree from metformin treatment than other men at high risk for type 2 diabetes.
... Genetic predisposition has been widely implicated in AGA. [31,38,39] Subjects with AGA in this study had a significant family history of AGA (46.5%, P < 0.001), especially in male family members, including fathers, brothers, and uncles. Several previous studies also confirm the family association. ...
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Introduction: Androgenetic alopecia (AGA) is a type of nonscarring alopecia with prevalence, pattern, and severity that have not been documented extensively in Nigeria and Africa. This study aimed to document AGA's prevalence and clinical characteristics among adults in Ogbomoso, Southwestern Nigeria. Methods: A community-based cross-sectional study of 260 consenting adults with AGA and 260 age- and sex-matched controls through a multistage sampling method. The survey for AGA was done using a pretested questionnaire. Data were analyzed with IBM SPSS version 20. Results: The overall prevalence of AGA was 29.95%, with a gender prevalence of 24.88% and 5.06% for men and women, respectively. The mean age of AGA was 51.32 ± 16.31 years, with a range of 24–90 years and male-to-female ratio of 4.9:1. The prevalence of premature AGA was 0.38%. Grade II vertex (13.8%) and VI (10.4%) were the most frequent male androgenetic alopecia severity grades, while grade IVa was the least common. Ludwig I was the most frequent female androgenetic alopecia severity grade (7.7%), followed by Ludwig II (6.9%) and III (2.3%). The mixed type of baldness was the most common (73.6%) phenotype, followed by frontal (20.8%), and vertex (4.2%) in men. Conclusion: Overall prevalence of AGA was 29.95%. The prevalence varies with location, age and gender with paternal family history as a significant risk factor. The mixed type of baldness is the most common phenotype.
... This difference can be explained by different control groups of both studies as the present study was conducted on groups of matched age, sex and BMI. As regards family history of AGA, the present study showed that there was no statistically significant difference between AGA patients and controls .These results were in agreement with Sreekumar et al., [10]), but in disagreement with Hirsso et al., [11]. These differences could be explained by small sample of patients included in the current study. ...
... Whereas few other studies revealed association of hypertension in persons with alopecia. 14,15,16,17 Our study revealed no significant association between hypertension and vertex baldness and thus differed with studies of Trevisan et al, 18 and Lotufo et al. 6 With increasing severity of vertex baldness from Grade-III vertex to Grade VII the percentage of subjects with cardiovascular risk factors was increased. 1 Further in depth analysis of our data showed a less percentage of subjects with Grade-VI baldness had elevated levels of TG, LDL and elevated TC/HDL ration in comparison to those who had less severe grade of baldness. ...
... Regarding other CHD associated risk factors, our data revealed higher point estimates for DM and BMI in men with MPB. These findings are in line with previous studies that reported a positive association between MPB and DM and insulin-linked disturbances in the Finish population [36] and MPB and increased risk of mortality from DM and heart disease in Taiwanese [9]. The study by Hirsso et al. (2007) and a meta-analysis by Trieu et al. (2014), also found a positive associations between MPB and BMI [31,37]. ...
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Male-pattern baldness (MPB) is characterized by a progressive hair loss from the frontal and vertex scalp that affects about 80% of men at the age of 80 years. Epidemiological studies show positive associations between MPB and coronary heart disease (CHD) and CHD related risk factors such as blood pressure (BP), diabetes mellitus (DM) or elevated blood lipid levels. The results however vary with regard to the pattern of hair loss (i.e. moderate, severe, frontal or vertex). Further, no study has investigated for a shared genetic determinant between MPB and CHD as well as CHD related risk factors. Using the longitudinal data from the population-based Heinz Nixdorf Recall study we aimed to systematically investigate the association between MPB and incident CHD and CHD risk factors on (i) an epidemiological (N = 1,673 males) and (ii) a genetic (N = 1,357 males) level. The prevalence of any baldness in our study population was 88% (mean age ± SD: 64±7.5 years). Compared to men with ‘no baldness’, in men with any kind of baldness a slightly increased risk for CHD (Hazard ratio [95% confidence interval (95%CI)] = 1.2 [0.8; 1.9]), a slightly higher extend of coronary artery calcification (CAC) (Beta [95%CI] = 0.2 [-0.1; 0.6]), a moderately increased risk for DM (prevalence ratio [95%CI] = 1.4 [0.9; 2.0]) and higher body mass index (BMI) (Beta [95%CI] = 0.6 [0.00003; 1.2]) seem to be indicated in the adjusted model. In contrast, the MPB genetic risk score did not show any association with CHD or CHD risk factors. Taken together, the results of our study suggest a weak association between MPB and a few CHD risk factors (CAC, DM and BMI) but do not point to MPB as a strong surrogate measure for CHD and CHD risk factors in general.
Chapter
Over the past six decades, there is increasing evidence on the epidemiological association and dose-response relationship between AGA and cardiovascular disease (CVD), metabolic syndrome (MetS), hypertension, and insulin resistance (IR).
Article
Background Early androgenetic alopecia (AGA) is patterned hair loss occurring before 30 years. Early AGA is frequently reported in men and carries the risk of obesity, metabolic syndrome, and cardiovascular diseases. Hyperuricemia used to be a minor component of metabolic syndrome. Recently, increasing number of studies has proved that hyperuricemia is an independent risk factor for many cardiovascular diseases and psoriasis. However, none of these studies have examined the relationship between hyperuricemia and AGA. Aims To determine the association between hyperuricemia and AGA in men. Methods A cross‐sectional case‐control study was conducted. The medical charts and photographs of men with a clinical diagnosis of AGA were reviewed. The clinical and laboratory data of AGA and control groups were compared. Results Men with AGA (n = 1312) had higher mean uric acid level (6.25 mg/dL vs 5.97 mg/dL; P < .001) and higher prevalence of hyperuricemia (25.0% vs 15.6%; P < .001) than those without AGA (n = 2624). There was no statistically significant association between AGA severity and hyperuricemia (P = .295). Conclusions Men with early AGA have a higher prevalence of hyperuricemia.
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To describe the prevalence of previously diagnosed and undiagnosed diabetes and impaired glucose tolerance (IGT) by sex, marital status, employment, exercise behaviour, and body mass index (BMI), and to compare previously diagnosed and undiagnosed diabetic patients. A survey of the total 55-year-old population living in a Finnish city on 1 October 1990. All the participants who were not on antidiabetic medication were invited for an oral glucose tolerance test (OGTT). Oulu, a city in northern Finland. 1,008 eligible subjects (456 men and 552 women), of whom 345 men (76%) and 435 women (79%) participated. The prevalence of previously diagnosed diabetes was 6.1% in the men and 3.0% in the women and that of previously undiagnosed diabetes 4.5% of the men and 3.7% of the women. The prevalence of IGT was 28.6% in the men and 26.7% in the women. Diabetes was related to BMI, and previously undiagnosed diabetes was related to the amount of physical exercise in both sexes. One third of the undiagnosed diabetic men and half of the undiagnosed diabetic women were identified among the persons with marked obesity (BMI 30 kg/m2 or more). The group of previously diagnosed diabetic patients included a significantly greater proportion of retired people and people on sick leave than the group of undiagnosed diabetic persons. Diabetes is common in middle-aged Finns. Undiagnosed diabetes was detected especially in persons with marked obesity who were not physically active.
Article
So far, it is a widely accepted opinion that androgenetic alopecia is caused by an autosomal dominant gene with reduced penetrance in women. This view is essentially based on a family study performed by Osborn in 1916. She believed that balding men would be either heterozygous (Bb) or homozygous (BB), whereas balding women would be homozygous (BB). By contrast, we here present five arguments favoring a polygenic inheritance of the trait: (1) the high prevalence of the trait, (2) the distribution of balding patterns in the general population along a gaussian curve of variation, (3) the fact that the risk increases with the number of relatives already affected, (4) the slightly increased risk of relatives of severely affected women as compared to the relatives of mildly affected women, and (5) the fact that a predisposition inherited from an affected mother is of greater importance than that inherited from an affected father. In conclusion, the simple mendelian model of Bb and BB can no longer be upheld.
Article
The authors assessed the relation between the extent and progression of baldness and coronary heart disease. Baldness was assessed twice, in 1956 and in 1962, in a cohort of 2,017 men from Framingham, Massachusetts. Extent of baldness was classified in terms of number of bald areas: no areas bald (n = 153), one area bald (n = 420), two areas bald (n = 587), and all areas bald (n = 857). Men who were assessed both times and who had two or fewer bald areas during the first evaluation were classified into one of three groups: "mild or no progression," "moderate progression," or "rapid progression." The cohort was followed for up to 30 years for new occurrences of coronary heart disease, coronary heart disease death, cardiovascular disease, and death due to any cause. The relations between the extent and progression of baldness and the aforementioned outcomes were assessed using a Cox proportional hazards model, adjusting for age and other known cardiovascular disease risk factors. Extent of baldness was not associated with any of the outcomes. However, the amount of progression of baldness was associated with coronary heart disease occurrence (relative risk (RR) = 2.4, 95% confidence interval (CI) 1.3-4.4), coronary heart disease mortality (RR = 3.8, 95% CI 1.9-7.7), and all-cause mortality (RR = 2.4, 95% CI 1.5-3.8). Rapid hair loss may be a marker for coronary heart disease.
Article
A large number of drugs may interfere with the hair cycle and produce hair loss. Drugs may affect anagen follicles through 2 main different modalities: (i) by inducing an abrupt cessation of mitotic activity in rapidly dividing hair matrix cells (anagen effluvium) or (ii) by precipitating the follicles into premature rest (telogen effluvium). In anagen effluvium, hair loss usually occurs within days to weeks of drug administration, whereas in telogen effluvium, hair loss becomes evident 2 to 4 months after starting treatment. Anagen effluvium is a prominent adverse effect of antineoplastic agents, which cause acute damage of rapidly dividing hair matrix cells. Telogen effluvium may be a consequence of a large number of drugs including anticoagulants, retinol (vitamin A) and its derivatives, interferons and antihyperlipidaemic drugs. Drug-induced hair loss is usually reversible after interruption of treatment. The prevalence and severity of alopecia depend on the drug as well as on individual predisposition. Some drugs produce hair loss in most patients receiving appropriate dosages while other drugs are only occasionally responsible for hair abnormalities. Both hirsutism and hypertrichosis may be associated with drug administration. Drugs most commonly responsible for the development of hirsutism include testosterone, danazol, corticotrophin (ACTH), metyrapone, anabolic steroids and glucocorticoids. Hypertrichosis is a common adverse effect of cyclosporin, minoxidil and diazoxide.
Article
The present report focuses on the association between baldness pattern and coronary heart disease risk factors in 872 male factory workers from southern Italy participating in an epidemiological study. Participants were divided according to presence or absence of baldness and baldness pattern. Participants with fronto-occipital baldness (male-type baldness) (n = 280) characterized by hair loss centered over the vertex with an m-shaped frontal-temporal recession had, on the average, higher serum cholesterol and blood pressure compared to participants with no baldness (n = 321) and/or participants with just frontal baldness (n = 273). For serum cholesterol, a significant interaction was detected between age and fronto-occipital baldness (i.e. the association between fronto-occipital baldness and elevated levels of serum cholesterol became weaker with age). No interaction was detectable between age and fronto-occipital baldness for blood pressure. The results of this cross-sectional study indicate that male-type pattern of baldness is associated with elevated CHD risk profile, and that this relation between age and serum cholesterol differs in younger compared to older men.
Article
To examine the relationship between male pattern baldness and the risk of myocardial infarction in men under the age of 55 years. A hospital-based, case-control study was conducted in eastern Massachusetts and Rhode Island. Cases were men admitted to a hospital for a first nonfatal myocardial infarction (n = 665); controls were men admitted to the same hospitals with noncardiac diagnoses (n = 772). Extent of baldness was assessed using the 12-point modified Hamilton Baldness Scale; other information was obtained by personal interview. Among the controls, the prevalence of any baldness was 34%, while the prevalence of baldness involving the vertex scalp was 23%. After allowing for age, the relative risk estimate for frontal baldness compared with no hair loss was 0.9 (95% confidence interval, 0.6 to 1.3), for baldness involving the vertex scalp it was 1.4 (95% confidence interval, 1.2 to 1.9). Risk of myocardial infarction increased as the degree of vertex baldness increased (P < .01); for severe vertex baldness the relative risk was 3.4 (95% confidence interval, 1.7 to 7.0). The relationship between vertex baldness and myocardial infarction was consistent within strata defined by age and other risk factors for coronary artery disease. These data support the hypothesis that male pattern baldness involving the vertex scalp is associated with coronary artery disease in men under the age of 55 years.
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To the Editor. —We appreciate the book review by Cromie and Kelleher1 of The Joy of Uncircumcising: Restore Your Birthright and Maximize Sexual Pleasure and Say No to Circumcision: 40 Compelling Reasons Why You Should Respect His Birthright and Keep Your Son Whole and believe it is important for physicians to read them to learn why thousands of men are dissatisfied with being circumcised. The main reason is a loss of sexual pleasure.Foreskin contains erogenous tissue with a high concentration of sensitive nerves. According to Dr Ritter, it comprises more than one third of the skin on the penile shaft, about 12 sq in for the average male. During erection part of the foreskin shifts to cover the upper shaft of the penis, a location that would contact the vaginal wall during intercourse and ease penetration. The penile shaft is designed to be loose not taut at erection
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A weak positive association between male pattern baldness and ischemic heart disease has been suggested previously. The authors examined this issue by using data from the Epidemiologic Follow-up Study of the First National Health and Nutrition Examination Survey. As part of the baseline medical examination between 1971 and 1975, the presence and degree of male alopecia (none, minimal, moderate, and severe) were recorded for a subset of participants. Among 3, 932 men aged 25–76 years who had complete data, 378 deaths and 939 incident events from ischemic heart disease occurred during an average follow-up period of 14 years. Among 2,019 men who were younger than age 55 years at baseline (61 deaths and 239 incident events of ischemic heart disease), severe baldness was positively associated with ischemic heart disease mortality (rate ratio = 2.51, 95% confidence interval 1.01–6.24) and somewhat less associated with ischemic heart disease incidence (rate ratio = 1.72, 95% confidence interval 0.96–3.08). No dose-response relation with degree of baldness was seen. Arthough these findings are tempered by the absence of information concerning the type of baldness (frontal or vertex), they provide support for earlier studies that indicate male pattern baldness that occurs before age 55 years may be by some mechanism related to ischemic heart disease.
Article
The previously proven association between androgenetic, alopecia and serious cardiovascular events raises a question of the common pathogenetic mechanism of these disorders. Our practice-based case-control study in men aged 19-50 years showed a strikingly increased risk of hyperinsulinaemia and insulin-resistance-associated disorders such as obesity, hypertension, and dyslipidemia in men with early onset of alopecia (<35), compared with age-matched controls. This finding supports the hypothesis that early androgenetic alopecia could be a clinical marker of insulin resistance.