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      Clinical Profile of Androgenic Alopecia and Its Association with Cardiovascular Risk Factors

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          Abstract

          Context:

          Androgenic alopecia (AGA) is a hereditary androgen-dependent disorder, characterized by gradual conversion of terminal hair into miniaturized hair and defined by various patterns. Common age group affected is between 30 and 50 years. Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors that include diabetes and prediabetes, abdominal obesity, dyslipidemia, and hypertension. The relationship between androgenic alopecia and MetS is still poorly understood.

          Aim:

          The aim was to study the clinical profile of androgenic alopecia and its association with cardiovascular risk factors.

          Materials and Methods:

          This was a hospital-based cross-sectional study done on men in the age group of 25–40 years. Fifty clinically diagnosed cases with early-onset androgenic alopecia of Norwood Grade III or above and fifty controls without androgenic alopecia were included in the study. Data collected included anthropometric measurements, blood pressure, family history of androgenic alopecia, history of alcohol, smoking; fasting blood sugar, and lipid profile were done. MetS was diagnosed as per the new International Diabetes Federation criteria. Chi-square and Student's t-test were used for statistical analysis.

          Results:

          MetS was seen in 5 (10%) cases and 1 (2%) control ( P=0.092). Abdominal obesity, hypertension, and lowered high-density lipoprotein were significantly higher in patients with androgenic alopecia when compared to that of the controls.

          Conclusion:

          A higher prevalence of cardiovascular risk factors was seen in men with early-onset androgenic alopecia. Early screening for MetS and its components may be beneficial in patients with early-onset androgenic alopecia.

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          Most cited references15

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          Serum aldosterone and the incidence of hypertension in nonhypertensive persons.

          Primary hyperaldosteronism is a well-recognized cause of secondary hypertension. It is unknown whether serum aldosterone levels within the physiologic range influence the risk of hypertension. We investigated the relation of baseline serum aldosterone levels to increases in blood pressure and the incidence of hypertension after four years in 1688 nonhypertensive participants in the Framingham Offspring Study (mean age, 55 years), 58 percent of whom were women. We defined an increase in blood pressure as an increment of at least one blood-pressure category (as defined by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) and defined hypertension as a systolic blood pressure of 140 mm Hg or higher, a diastolic blood pressure of 90 mm Hg or higher, or the use of antihypertensive medications. At follow-up, the blood-pressure category had increased in 33.6 percent of the participants, and hypertension had developed in 14.8 percent. In multivariable models, a 16 percent increase in the risk of an elevation in blood pressure (P=0.002) and a 17 percent increase in the risk of hypertension (P=0.03) were observed per quartile increment in the serum aldosterone level. The highest serum aldosterone quartile, relative to the lowest, was associated with a 1.60-fold risk of an elevation in blood pressure (95 percent confidence interval, 1.19 to 2.14) and a 1.61-fold risk of hypertension (95 percent confidence interval, 1.05 to 2.46). The associations between the serum aldosterone level and blood-pressure outcomes were not significantly affected by adjustment for urinary sodium excretion or left ventricular thickness or internal dimensions. In our community-based sample, increased aldosterone levels within the physiologic range predisposed persons to the development of hypertension. Copyright 2004 Massachusetts Medical Society
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            Early androgenetic alopecia as a marker of insulin resistance.

            The previously proven association between androgenetic, alopecia and serious cardiovascular events raises a question of the common pathogenetic mechanism of these disorders. Our practice-based case-control study in men aged 19-50 years showed a strikingly increased risk of hyperinsulinaemia and insulin-resistance-associated disorders such as obesity, hypertension, and dyslipidemia in men with early onset of alopecia (<35), compared with age-matched controls. This finding supports the hypothesis that early androgenetic alopecia could be a clinical marker of insulin resistance.
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              Association of androgenetic alopecia and hypertension.

              Androgenetic alopecia is considered to be associated with coronary heart disease but the explanation of this association remains unknown. Hypertension is highly prevalent in patients with coronary heart disease. Essential hypertension is linked to hyperaldosteronism and spironolactone, an antihypertensive drug which is a mineralocorticoid receptor antagonist, has been used for a long time in the treatment of androgenic alopecia. We recently observed in a double transgenic mouse model that overexpression of a mineralocorticoid receptor targeted to the skin induced the development of alopecia. We prospectively studied the association of hypertension and androgenetic alopecia in Caucasian men. Two hundred and fifty Caucasian men aged 35-65 years were consecutively recruited by 5 general practitioners (50 per practitioner). Data collected included age, androgenetic alopecia score with a simplified Norwood's score (0-4), blood pressure or history of hypertension, smoking, history of diabetes mellitus or hyperlipidemia, familial history of androgenetic alopecia, and treatment. Chi-square, Fisher exact tests and linear regression model were used for statistical analysis. Hypertension was strongly associated to androgenetic alopecia (p < 0.001). Linear regression tests confirmed that this association was independent of age : odds ratio was 2.195 (95% CI : 1.1-4.3). Familial history of androgenetic alopecia was also strongly associated with androgenetic alopecia : odds ratio was 10.870 (95% CI : 4.3-27.1). Other variables (diabetes mellitus, hyperlipidemia, smoking, treatment) were not associated with androgenetic alopecia. We were limited by a relatively small study sample but in this study androgenetic alopecia was strongly associated with hypertension. Association of androgenetic alopecia and hyperaldosteronism warrants additional studies. The use of specific mineralocorticoid receptor antagonists could be of interest in the treatment of androgenetic alopecia.
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                Author and article information

                Journal
                Indian J Dermatol
                Indian J Dermatol
                IJD
                Indian Journal of Dermatology
                Medknow Publications & Media Pvt Ltd (India )
                0019-5154
                1998-3611
                Jan-Feb 2019
                : 64
                : 1
                : 19-22
                Affiliations
                [1] From the Department of Skin and VD, Shree Krishna Hospital, Anand, Gujarat, India
                [1 ] Department of Skin and VD, Amrita Institute of Medical Sciences, Kochi, Kerala, India
                Author notes
                Address for correspondence: Dr. Rita V Vora, Department of Skin and VD, Shree Krishna Hospital, Karamsad, Anand - 388 325, Gujarat, India. E-mail: ritavv@ 123456charutarhealth.org
                Article
                IJD-64-19
                10.4103/ijd.IJD_526_16
                6340244
                30745630
                6e65e529-7a21-46c3-a304-1078411cb032
                Copyright: © 2019 Indian Journal of Dermatology

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : August 2016
                : June 2018
                Categories
                Original Article

                Dermatology
                androgenic alopecia,cardiovascular disease,metabolic syndrome
                Dermatology
                androgenic alopecia, cardiovascular disease, metabolic syndrome

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