Screening for Metabolic Syndrome in Patients with Androgenetic Alopecia: Are we ready to make it the standard of care?

New Meta-Analysis Points to Three Fold increased Risk of Metabolic Syndrome in Androgenetic Alopecia

Metabolic syndrome refers to the group of abnormalities that increase the risk for cardiovascular disease. Metabolic syndrome includes issues like high blood sugars, high cholesterol, high blood pressure and central obesity. It’s been clear for many years that patients with androgenetic alopecia areata at increased risk for metabolic syndrome.

I’ve written on the subject in past articles

Article 1: Metabolic Syndrome and Why it Matters

Article 2: The Time is Ripe for the Medical Community to Come Together

Article 3: Hair Loss and Obesity

Article 4: Heart Disease and Balding: A Look Back at Cotton et al, 1972

Qui et al, 2022: A Third Meta-Analysis Study Examining Metabolic Syndrome in Those with Androgenetic Alopecia

Authors from China recently set out to perform a systematic review and meta-analysis of the literature to clarify and illustrate the prevalence of MetS in patients with AGA compared with control individuals.

The authors identified 19 articles, including 1,342 patients with AGA and 1,189 controls, and these were included in meta-analysis. All 19 articles were in English language and had a case-control design. The authors chose to exclude cross sectional studies which don’t control for factors in the same ways as case control studies. The 19 studies were from 9 countries on 4 continents. The sample size ranged from 68 to 202 participants.

Results

The pooled OR for the prevalence of MetS between the AGA and control group was 3.46 (95% CI: 2.38–5.05; p < 0.001). In 18 of 19 studies, the prevalence of MetS by sex was clearly reported (in 2,151 men and 220 women). The pooled OR in males was 3.08 ( p < 0.001) and in females 7.34 ( p < 0.001)

Both early onset and typical onset AGA were associated with metabolic syndrome. However the link was closer for early onset AGA suggesting that younger age might have a closer relationship with MetS. The pooled ORs in patients without early-onset was 3.13 (p < 0.001) and the pooled ORs in patients with early-onset was 3.88 ( p<0.001).

Studies from individuals of African and Asian backgrounds showed a higher incidence of metabolic syndrome compared to those from Europe.

Finally these studies confirmed that patients with androgenetic alopecia had significantly poorer metabolic profiles, such as body mass index, waist circumference, fasting glucose, blood lipids, and blood pressure.

Conclusion and Comments

In conclusion, the authors showed that androgenetic alopecia was associated with an increased odds ratio for metabolic syndrome, which was greater in women and in patients with early-onset AGA and African and Asian ethnicity.

I really like this study. It highlights the risk in women and the risk in those with early onset AGA. It’s not the first meta-analysis to be done but it was a carefully done meta-analysis which analyzed “only” case control studies.

So what were the other meta-analyses that were published?

In 2014, Wu et al showed an OR 2.70, (95% CI: 1.67–4.37) for AGA and metabolic syndrome. Caro-Chang et al, 2019 was another meta-analysis and showed that patients with AGA had a greater chance of developing MetS with an OR 2.59 (95% CI 1.51–4.44; ). This study, like the study by Qiu and colleagues I discussed above, showed that female patients and patients with early-onset AGA had significant associations with MetS (OR 5.59 and OR 3.69, respectively).

Overall, it’s such as important reminder that we need to be talking about risks for metabolic syndrome in our patients with AGA. We need to make sure blood pressure gets measured in all our patients with AGA, screening for diabetes and insulin resistance gets done and that weight is measured often and patients are encourage to keep weight in a healthy range.

Possible Guidelines for Monitoring the Patient AGA

We do not yet have screening guidelines in the world for how best to monitor males and females with AGA. We now know with great confidence that males and females with androgenetic alopecia have an increased risk of developing metabolic syndrome and cardiovascular disease later in life. I feel strongly that our medical community has neglected this issue but nevertheless we have guidelines in our clinic that we feel are appropriate first steps. In our clinic,  we recommend the following: 

1.    Encouragement of healthy eating and diets rich in antioxidant rich fruits and vegetables. 

2.    Encouragement of active lifestyles with 300 minutes of physical exercise weekly.

3.    Smoking cessation strategies for all smokers and encouragement to not begin smoking.

4.    Blood pressure measurements at baseline and then yearly by the family physician. Encourage of home monitoring in those with borderline measurements. Treatment of hypertension with lifestyle and pharmacological means as recommended by current evidence based guidelines

5.    Cholesterol levels at baseline and then every 3-5 years if normal at baseline.  Aggressive treatment of abnormal cholesterol level according to current evidence based guidelines.  

6.    Fasting glucose insulin and hemoglobin A1c levels at baseline and every 3-5 years if normal at baseline.  Consideration of further tests for insulin resistance as appropriate.

7.    Weight and height measurements yearly and evidence based weight reduction strategies if weight is found to be in the overweight or obese ranges

Are we not ready yet as a medical community to make this the standard of care? We are now approaching 50 years since a link between heart disease and hair loss was first uncovered. It’s about time.

If interested, you may wish to review a longer answer I gave from a recent webinar:

REFERENCES

Caro-Chang et al. Androgenetic alopecia and its association with metabolic syndrome: a systematic review and meta-analysis. Acta Medica Philippina 2019; 53: 122–131.

Qui Y et al. Systematic Review and Meta-analysis of the Association Between Metabolic Syndrome and Androgenetic Alopecia. Acta Derm Venereol. 2022 Feb 8;102:adv00645

Wu D-x, Wu L-f, Yang Z-x. [Association between androgenetic alopecia and metabolic syndrome: a meta-analysis]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2014; 43: 597–601 (in Chinese)