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Many researchers and physicians have raised the issue that hair loss is related to health; the first physician did so almost 200 years ago. In 1812, Napoleon marched into Russia with 500,000 men and retreated with only 40,000. His chief surgeon noted that bald men were the first to die [2]. As mentioned above, physicians are now associating hair loss with coronary artery disease.
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A recent study performed by Lesko et al reexamined the influence of hair loss on coronary artery disease [3]. They compared 665 men who had suffered non-fatal heart attacks to 772 men who had been admitted to the same hospitals for non-cardiac reasons. They found that the risk of a heart attack increased in proportion to the degree of vertex balding. Men under the age of fifty-five with moderate hair loss on top of their heads had approximately a 30% increase in the risk of suffering from a heart attack compared to nonbalding men; those with extreme hair loss had over a 300% increased risk.
Currently, researchers theorize that heart disease may be associated with the levels of dihydrotestosterone. Since this hormone is the major contributor to androgenic alopecia, it would provide a link between heart disease and hair loss in individuals under the age of fifty-five. In contrast, the hair loss that is observed in older individuals is thought not to be caused by increased levels of dihydrotestosterone and does not appear to correlate with heart disease. Recall that dihydrotestosterone affects other organs in the body, including the prostate. It is certainly possible that it may also affect the heart. Its exact role in heart disease remains to be elucidated.
Another study adds yet more information about the association between androgenic alopecia and heart disease. Trevisan et al examined this association and also measured serum cholesterol levels [4]. They found that, in addition to androgenic alopecia being a risk factor for coronary heart disease, serum cholesterol levels were significantly higher in participants with androgenic alopecia compared to those without it. Also, the association between higher serum cholesterol levels and androgenic alopecia became weaker with increased age; that is, the older the person, the less significant this association. Again, the hair loss we experience as we age is a completely separate entity from androgenic alopecia. Both these studies clearly indicate that heart disease is associated with the hair loss that is due to androgenic alopecia and not with the hair loss that accompanies aging.
As discussed earlier in this book, dihydrotestosterone is a steroid hormone. All steroid hormones are formed from cholesterol. This means that without cholesterol, you would not be able to manufacture dihydrotestosterone. The process by which these substances affect both heart disease and hair loss still needs to be determined. However, one possibility is that individuals with high levels of serum cholesterol may have increased risk of heart disease, and at the same time, produce higher levels of dihydrotestosterone. In other words, the same cholesterol that contributes to blocking arteries is also required to make dihydrotestosterone. In individuals with androgenic alopecia this hormone leads to hair loss. Another possibility is that the same atherosclerotic process that blocks the small coronary arteries in the heart may also block the microvasculature that nourishes the hair follicles. For now, however, these are only theories.