Hair Loss and Heart Attacks

Posted on by Jesse Santiano, M.D.
Hair loss can be a sign of a future heart attack. Hair loss affects 50 million men and women in the U.S. The most common pattern is Androgenic Alopecia (AGA).
For this article, androgenic alopecia will be referred to as hair loss.
Patterns of hair loss differ between men and women.
In Male Pattern Hair Loss (MPHL), hair loss starts from the temples and extends into the crown of the head. MPHL can eventually lead to total balding.
For Female Pattern Hair Loss (FPHL), the whole scalp area becomes thin but rarely leads to complete balding.
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Male Pattern Hair Loss aka “Top Gone”

The Association Between Hair Loss and Heart Attacks

Multiple studies show that AGA is associated with coronary artery disease. In a study of 85 men in Finland, the authors discovered that the younger the onset of hair loss, the higher the risk of severe coronary artery disease that is so serious that it will eventually require coronary artery surgery.[1]

In males 63 years and older, an association has been established between the severity of hair loss, hypertension, and diabetes[2]. Both conditions are related to insulin resistance.  The association between heart disease and hair loss is the same for men and women [3].

The risk factors that lead to heart attacks like metabolic syndrome, insulin resistance, hypertension, and high triglycerides are common in hair loss in an analysis of  29,254 participants [4].

The same study also found out that the more hair loss, the higher is the severity of coronary artery disease.

How Can Hair Loss and Heart Attacks Be Related?

Thinning hair may look like the hairs are missing or have stopped growing. In reality, the hairs are still there; however, the active growing phase (anagen) that usually takes three to five years becomes shorter.

It is during the anagen phase that the hair strand becomes thick and long.  If the hair stays in its inactive phase longer (catagen and telogen phase), the hair stays short and thin, making the scalp look sparse.

Eventually, it may progress to the total loss of hair.

Trichoscopy_AA
In AGA, the actively growing thicker hairs are replaced by smaller and fine hairs that are not readily seen, thus giving hair loss.

The Science behind Hair Loss (Androgenic Alopecia)

Dihydrotestosterone (DHT) is the critical hormone in causing hair loss. The enzyme 5-alpha reductase converts the testosterone that is present in males and females into DHT.

If there is an excess of 5-alpha reductase, more DHT gets produced, and a high DHT level activates the genes that shorten the active part of the hair growth cycle[5].

High levels of DHT have been found in the balding scalp [6]. High levels of male hormones are also found in females with polycystic ovarian syndrome (PCOS)

Insulin resistance and its consequences like metabolic syndrome, diabetes, and obesity lead to high levels of 5-alpha reductase [7].

Since 5-alpha reductase is involved in hair loss, medications that prevent the action of  5-alpha reductase, like finasteride, are prescribed to restore hair growth. However, if there is underlying insulin resistance, then the main problem is unaddressed.

Summary

Insulin resistance leads to an increase in 5-alpha reductase enzymes that convert testosterone to more DHT and shorten the active growing phase of the scalp hairs.

The prolonged inactive period of the hairs makes them look invisible, giving an appearance of thinning hair in women and baldness in men.

Take Away Message

If you notice thinning of the scalp hair, consider the possibility of insulin resistance. Talk to your physician if there is a need to screen for diabetes and other cardiac risk factors.

After checking your blood pressure, weight, and waist circumference, your physician might request a fasting blood sugar and lipid profile.

Early detection of underlying diseases related to hair loss will return healthy hair and prevent deadly diseases.

Intermittent fasting can reverse insulin resistance, but you have to talk to your doctor first to take diabetes and hypertension medicines.

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  8. Autophagy – How to Recycle Yourself
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  10. If You Know Anybody Male who is 55 and Older, Read This!

References:

  1.  Matilainen et al., Early onset of androgenetic alopecia associated with early severe coronary heart disease: a population-based, case-control study.  2001 Jun;8(3):147-51.
  2.  Hirsso et al., Association of insulin resistance, linked diseases and hair loss in elderly men. Finnish population-based study. 2006 Jun;14(2):78-81. 
  3. Arias-Santiago et al., Androgenetic alopecia and cardiovascular risk factors in men and women: a comparative study. 2010 Sep;63(3):420-9. doi: 10.1016/j.jaad.2009.10.018. Epub 2010 Jul 8.
  4. Trieu et al., Alopecia and its association with coronary heart disease and cardiovascular risk factors: a meta-analysis. 2014 Oct 20;176(3):687-95. doi: 10.1016/j.ijcard.2014.07.079. Epub 2014 Aug 1.
  5. González-Saldivar et al., Skin Manifestations of Insulin Resistance: From a Biochemical Stance to a Clinical Diagnosis and Management. 2017 Mar;7(1):37-51. doi: 10.1007/s13555-016-0160-3. Epub 2016 Dec
  6. SCHWEIKERT et al., Regulation of Human Hair Growth by Steroid Hormones. I. Testosterone Metabolism in Isolated Hairs, The Journal of Clinical Endocrinology & Metabolism, Volume 38, Issue 5, 1 May 1974, Pages 811– 819, https://doi.org/10.1210/jcem-38-5-811 
  7. Tomlinson et al., Impaired glucose tolerance, and insulin resistance are associated with increased adipose 11beta-hydroxysteroid dehydrogenase type 1 expression and elevated hepatic 5alpha-reductase activity. 2008 Oct;57(10):2652-60. doi: 10.2337/db08-0495. Epub 2008 Jul 15.
  8. Ustuner, Cause of Androgenic Alopecia: Crux of the Matter. . 2013 Oct; 1(7): e64. 

Image Credits:

  • Male Pattern Hair loss By BlaiserPascal – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=77333184
  • Trichoscopy images of alopecia areata. Author: Adriana Rakowska

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