TAKING HAIR LOSS TO HEART
Shiny domes may signify an elevated susceptibility to heart attacks

IN THE PAST 10 years several studies have hinted that baldness is more than an embarrassment; it can be a visible warning of increased risk for heart disease. Last year the largest study yet conducted confirmed that notion.

The investigation, headed by JoAnne E. Manson of Harvard Medical School's Brigham and Women's Hospital, looked at participants in the Physicians' Health Study, a long-term project that examined the risks for heart disease in some 22,000 male physicians. Eleven years into the project, the doctors , who were then between the ages of 51 and 95, indicated which of five pictures most closely approximated their hair pattern when they were 45. Most men who go bald lose their hair in a standard sequence, although at different rates. First, the hairline recedes near the temples. Next, the hair at the crown, or vertex, begins to go. Then the hairlije rises farther and the bald spot at the crown grows, until two areas meet.

Manson and her colleagues correlated the hair patterns with heart problems that had arisen in 19, 112 subjects who had no cardiovascular problems at the start of the Physicians' Health Study. Physicians who dies during the 11-year period were not evaluated, so the link between baldness and fatal heart attacks could not be assessed. But the researchers could look at the connection between hair loss and other "coronary events," namely notfatal heart attacks, angina or treatment for heart disease (by-pass surgery or angioplasty).

When potential confounding influences were eliminated, the results showed that, regardless of age, men with frontal baldness alone were only slightly more likely (9 percent) to fact heart problems than were men who retained all their hair. But those with mild thinning at the crown has a 23 percent higher risk of heart disease, and those with moderate or severe balding at the crown had more than a 30 percent higher risk.

Worst off were severely bald men with high cholesterol levels or high blood pressure. Those with elevated cholesterol were almost three times more likely to have heart disease that were men with high cholesterol and hair on their pates. Bald subjects with raised blood pressure faced almost twice the risk encountered by their counterparts with lusher hair.

Researchers can only speculate about why bald men would be more susceptible to heart disease. Genetic inheritance could be at fault, or high levels of male hormones (andogens) or increases sensitivity to them could be the common denominator. Androgens, Mason notes, play a part in male-pattern baldness and appear to contribute to atheroscierosis and increased blood clotting, both of which promote heart disease.

Obviously, baldness does not cause heart attacks. It can, however, serve as a daily reminder to take preventive measures. The drill should be familiar by not; avoid smoking, get regular exercise, eat right and keep blood pressure and cholesterol levels in the normal range.
Will taking drugs aimed at preventing hair loss also protect against heart disease? Manson received a flood of e-mails last year asking that very question. Sorry, she says, No evidence suggests it will. -RLR

STANDARD CLASSIFICATION SCHEME for the progression of male-pattern baldness, the Norwood-Hamilton scale, includes the heads depicted here. In a less typical pattern (not shown), the hairline rises progressively to the back of the head but a discrete bald spot never forms. The heart study described above presented a simplified version of the scale.