Does age related macular degeneration occur more frequently in AGA?

Macular Degeneration May be More Common in Androgenetic Alopecia

Authors of a new study set out to evaluate whether patients with AGA are at risk for macular degeneration and whether simple blood tests for microinflammation could asses the risk.

To do so, the authors performed a case control study with 40 patients with AGA aged 40 years or more of both sexes and 40 control subjects. Patients underwent examinations of the skin and eyes. Blood tests were performed for a variety of tests including the monocyte to HDL ratio (MHR) which authors felt was a good marker of ‘microinflammation.’

The authors found that the mean MHR was significantly higher in AGA patients (6.98 ± 2.21) than in controls (3.82 ± 0.68) (P < 0.001). Surprisingly the authors found that 80 % of AGA patients were diagnosed with age related macular degeneration compared to just 20% of control subjects. Male patients with more severe AGA were more likely to have macular degeneration. Interestingly, the mHR was significantly higher in AGA patients found to have AMD (9.37 ± 1.1 and 7.01 ± 1.42 in the wet and dry type respectively) compared to patients without AMD (P < 0.001).

Conclusions and Discussion

This is an unexpected report. The authors suggest that macular degeneration may develop more frequently in those with androgenetic alopecia. Moreoever the authors propose that the MHR might serve as a potential biomarker for predicting AMD in AGA patients.

A Brief Overview of the MHR in Cardiovascular Diseases

For those not aware, I’d like to spend a moment talking about monocytes and HDL and how these all factor in when it comes to inflammation. Inflammatory cells known as monocytes are known to be major source of “proinflammatory” species during atherogenesis. In atherosclerosis, modified low-density lipoproteins (LDLs) are removed by macrophages; these are recruited in the vessel wall, inducing the release of inflammatory cytokines in inflamed tissue. Hence, inflammatory cholesterol ester-loaded plaque is generated.

High-density lipoprotein-cholesterol (HDL-C) exhibits “anti-atherosclerotic” effects by neutralizing the pro-inflammatory and pro-oxidant effects of monocytes. HDL does this by inhibiting the migration of macrophages and LDL oxidation in addition to the efflux of cholesterol from these cells. Furthermore, HDL plays a role in blocking the activation of monocytes and proliferation-differentiation of monocyte progenitor cells.

Taken together it has been proposed that the accumulation of monocytes and reduction of HDL-C may participate in atherosclerosis and cardiovascular disease.

MHR has been found to increase with age and with a variety of inflammatory diseases including fatty liver, insulin resistance, post stroke depression, resistance blood pressure problems, sleep apnea, pulmonary hypertension. In psoriasis, MHR is closely linked to the PASI (severity) score. These are only a short list of inflammatory conditions linked to MHR

REFERENCE

Shams GM et al. Age-Related Macular Degeneration in Patients with Androgenetic Alopecia: Could the Monocyte/HDL Ratio Be the Link? Dermatol Pract Concept. 2023 Oct 1;13(4). doi: 10.5826/dpc.1304a285.

Ganjali S et alMonocyte-to-HDL-cholesterol ratio as a prognostic marker in cardiovascular diseases. J Cell Physiol . 2018 Dec;233(12):9237-9246.