Dr Margaret answers emailers’ embarrassing problems
in this monthly problem page.

Baldness and heart attacks

Dear Dr Margaret
In a magazine I came across a story about balding at the top of the head being related to heart attack. I will be 40 years old soon, and I started being bald when I was 36. Does that mean I am at risk of a heart attack?

There is a link between baldness and increased risk of heart attack. This was shown in a study of 19,000 male American doctors. The researchers already had data on heart problems (such as heart attacks and angina) in these doctors. They sent the doctors diagrams of balding heads, and asked which picture most resembled their hair pattern when they were 45 years of age. Some of the pictures showed a receding hairline, and others showed hair loss at the top of the head.

The results were interesting. Compared with non-bald men, those who had lost most of the hair from the top of their head by age 45 had a 36% greater likelihood of coronary heart disease. Those with a smallish bald patch on the top of the head at age 45 had a 23% greater likelihood of coronary heart disease than non-bald men. For those with only a receding hairline at age 45, the risk was slightly increased (by 9%).

The reason for the connection between baldness and heart disease is not properly understood, but it seems to depend on the way the various cells of the body interact with hormones, such as insulin and testosterone (the male hormone).

Of course, the baldness is not directly causing the coronary heart problems. It is just a signal that your body metabolism makes you slightly more at risk of heart problems than other people, so it is a useful early warning. It is just one risk factor among many, and does not mean that a heart attack is inevitable in your case. Some good news is that a Danish study, in which 13,000 people were monitored for 16 years, found that those with baldness did not generally die at a younger age than non-bald people.

There is plenty that you can do to reduce your risk of a heart problem. In the study of American doctors, the greatest risk was in men who also had high blood pressure and/or high cholesterol levels. So ask your family doctor to check your blood pressure and to do a simple fasting blood test for diabetes (because diabetes also increases heart attack risk). Your doctor could also check your cholesterol levels.

If you are overweight, losing just a few pounds will reduce your risk. Become a bit more active. And if you are a smoker, stop straight away – this is probably the single most important thing you can do to improve the health of your arteries.

It is not just bald men who have an increased risk of heart attack – men with greying of the hair and wrinkling of the skin are as well. This connection could be partly due to smoking, because cigarettes cause skin wrinkles as well as damage to arteries.

Sources of information
Lotufo PA et al. Male pattern baldness and coronary heart disease. Archives of Internal Medicine 2000;160:165–71.

Schnohr P et al. Gray hair, baldness and wrinkles in relation to myocardial infarction. American Heart Journal 1995;130:1003–10.

Schnohr P et al. Longevity and gray hair, baldness and facial wrinkles and arcus senilis in 13,000 men and women: the Copenhagen City Heart Study. Journals of Gerontology. Series A. Biological Science and Medical Science 1998;53:347–50.

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