Balding and Heart Disease: Does a Disappearing Hairline Reflect Heart Disease Risk?

Beauty may come from within, but a recent study out of Copenhagen, Denmark suggests that how you look externally could actually be a reflection of internal health problems.  The researchers found that visibly apparent signs of aging, regardless of actual chronologic aging, increased the participants’ risk of heart disease.

More specifically, researchers followed over 10,000, 40 and older participants from the Copenhagen Heart Study for over 35 years.  Individuals were evaluated for gray hair, balding, wrinkles, earlobe creases, and xanthelasma, or fatty growths on the eyelids.  Demonstrating balding at the crown, hairline recession at the temples, yellowish fatty growths on the eyelid, or an earlobe crease increased the risk for heart disease by 39% and increased the risk for heart attack by 57%.  The risk was independent of other more commonly cited risks for heart disease such as high cholesterol.

These findings mimic results from the Framingham Heart Study and the First National Health and Nutrition Study which also found an association between balding and heart disease.  Even in a study of over 20,000 seemingly healthier over 40 year old physicians, balding was associated with heart disease. 

All of the abovementioned studies were large cohorts that were followed over decades looking for any possible risks for heart disease.  So there are many potential confounding factors that could be playing a role in the results found.  For this reason a group of researchers from Johns Hopkins conducted a study of men with known histories of heart attacks and evaluated them for the presence of balding.  Interestingly, they could not find a significant association between balding and heart disease.

The other interesting consideration for the Copenhagen Study is the fact that all the patients are from a generally homogenous population in Denmark.  We all know the adage, “Black don’t crack.”  Thus, it would be intriguing to repeat the study in patients of African descent, because although we do not seem to show signs of aging as readily as our lighter skinned counterparts, we certainly do not enjoy lower rates of heart disease.  So, it would be interesting to see if the same attributes are found to increase heart disease risk amongst patients of African descent.In summary, although, the association between balding and heart disease is indeed fascinating, the main question is what we do as physicians with these possible associations.  Most patients over 40 should be seen regularly by their primary care physician and evaluated for cardiac risk factors, anyhow.  Potentially balding, earlobe creases, and xanthelasma could be used in addition to other risk factors to calculate overall risk of heart disease. 

However, as a dermatologist that specializes in hair loss, I am not so sure that I will be re- directing each one of my balding patients to their primary care physicians for a cardiac evaluation, based on the presence of balding alone.

Advances in the Cure for Balding: Platelet Rich Plasma

Most think of platelets as the component of blood that coagulates wounds.  However, the function of platelets is far more than just forming clots.  When activated, they secrete cytokines and growth factors, acting as an integral part of wound healing.  Because of platelet's important function, concentrated preparations of plasma have been used in various fields as an attractive therapy for many conditions.

Platelet Rich Plasma or PRP is a preparation taken from a patient’s own blood, in which the platelets are enriched in concentrated plasma.  The therapy was originally used for injections into damaged joints in the orthopedic field.  Now it is being used by cosmetic dermatologists and plastic surgeons for overall facial rejuvenation.

Recently, hair specialists have been trialing the therapy in patients who are balding.  Animal studies show that PRP increases dermal papilla cells, which are decreased in individuals with balding.  Potent hair growth stimulators, Fibroblast growth factor-7 and Beta-catenin, are also increased by PRP treatment.  In addition, mice treated with PRP have quicker transitions into the growing phase of hair than untreated mice.  

When used as an adjunct to hair transplantation, hair follicles pre-treated with PRP can demonstrate better density and graft survival.  The theory is that the platelets are secreting growth factors, leading to stem cell activation from the surrounding hair follicles.  

Because of the improved hair growth seen with hair transplantation and the above-mentioned animal studies, hair specialists have started using PRP as primary treatment for male and female pattern balding.  PRP treatment is particularly attractive for women who have not seen great results with minoxidil and young men who may not be suitable candidates for finasteride or hair transplantation.  

Although, PRP seems to be a promising advancement in the field of hair loss, there have not been many published, large human clinical trials for its use as a treatment in balding.  Therefore, many hair specialists have not adopted its use widely because the amount of benefit is unclear and most importantly, there is no consensus on how often the injections should be given or at what concentration.  

Thus, Platelet Rich Plasma or PRP injections are an enticing new treatment for balding.  However, widespread implementation of its use may not be seen until larger studies can demonstrate its efficacy and ideal protocol for administration.  In the future, PRP treatments may act as an adjunct to more well-studied treatments, such as minoxidil, finasteride, and hair transplantation, as opposed to primary therapy.