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.