By: Thomas Pickering, MD, DPhil, FRCP, Director of Integrative and Behavioral Cardiology Program
of the Cardiovascular Institute at Mount Sinai School of Medicine, New York.

Several studies have suggested that men who become bald at an early age may be at increased risk for coronary heart disease, but the evidence has been inconsistent. Now the Physicians’ Health Study, whose findings we feature regularly, has come up with further support for the idea.

The study involved analysis of the records of 22,000 US male physicians, who have answered extensive questions about their health and lifestyles, and who have been followed for an average of 11 years to see which ones have heart attacks and related disorders. The main finding was that men who start to go bald by the age of 45 do have an increased risk of heart attacks, which is independent of other risk factors such as age, cholesterol etc. And the more extensive the hair loss, the bigger the risk. Thus if it’s just frontal baldness (receding at the temples), the increased risk is less than 10% (in comparison with a man who has no substantial hair loss), whereas if the whole vertex (top of the head) is bald, the risk goes up by 36%. In men who are also hypertensive (a blood pressure above 160/95, or taking blood pressure-lowering medications), vertex baldness increases the risk by 79%, and in men who have high cholesterols (above 250mg/dl, or 6.47mmol/L) it goes up by 278%- i.e. more than double.

Doctor’s comments

This is not the first study to report an association between premature baldness and heart disease, but it is the largest, and generally confirms the earlier ones. The explanation is not clear, but may have to do with male hormones (testosterone). Thus men who lose their hair at an early age tend to have high testosterone levels in their blood, and there is some evidence that testosterone may have some bad effects from the point of view of heart disease- it makes blood platelets more sticky and impairs the function of the endothelium (lining of the arteries). So if you are prematurely bald, what should you do? There is nothing to suggest that treating the baldness will have any effect, so we would classify it as a 'non-modifiable' risk factor. The best answer is probably to make sure that your other risk factors that are modifiable (particularly cholesterol and blood pressure) are adequately treated.

Where it was published

PA Lotufo and colleagues. Male pattern baldness and coronary heart disease. The Physicians’ Health Study. Archives of Internal Medicine. 2000; 160: 165.