Patients with Scarring Alopecia Are At Risk for Cardiovascular Disease

Males with Primary Scarring Alopecia are At Particularly Increased Risk

Authors of a new study set out to determine if patients with primary scarring alopecia are at increased risk to develop cardiovascular disease, coronary artery disease or stroke. The authors from Korea performed a nationwide longitudinal cohort study of 406,016 patients including 7,986 with primary scarring alopecia, 78,590 with non scarring alopecia and 319, 440 controls without hair loss. Patients were from the National Health Insurance Service (NHIS) database from 2013 to 2020. Patients were followed up until Dec 31 2020 or until they had a cardiovascular disease event or died.

The scarring alopecias studied included pseudopelade of Brocq (PPB), lichen planopilaris/frontal fibrosing alopecia (LPP), folliculitis decalvans (FD), dissecting cellulitis (DC). A category called cicatricial alopecia unspecified (CAU) was also included in this study.

The mean age of patients was 36.3 years, and 65.4% were men. Patients with PCA tended to have more underlying diseases and higher body mass index and FSG levels than controls.

 Patients with Scarring Alopecia have increased Risk for Heart Disease

After fully adjusting for potential confounders (like age, sex, household income, smoking, alcohol intake, physical activity, systolic blood pressure, fasting serum glucose, total cholesterol, and Charlson comorbidity index), patients with PCA had an increased risk of CVD (aHR 1.18; 95% CI 1.01-1.38) and CHD (aHR 1.26; 95% CI 1.02-1.55) compared to controls

Folliculitis Decalvans Patients

Patients with FD had an elevated risk of CVD (aHR 1.29; 95% CI 1.04-1.61) and stroke (aHR 1.39; 95% CI 1.05-1.84) compared to controls.

Lichen planopilaris/FFA Patients

Patients with LPP (aHR 1.93; 95% CI 1.07-3.49) had an increased coronary heart disease risk compared to controls.

Risk by Sex

When evaluated by sex it was found that males with PCA had a much greater risk of CVD, CHD and stroke compared to females. In fact, the risk was mainly in males

Conclusion

All in all, the authors found that patients with PCA had an increased CVD risk compared with controls without alopecia. In particular, among the subtypes of PCA, FD or LPP was significantly associated with an elevated risk of CVD, CHD, or stroke. Dissecting Cellulitis and Pseudopelade of Brocq did not appear to have any associated risk.

It’s not clear exactly why patients with scarring alopecia have this risk. It has been hypothesized that abnormal lipid metabolism might be a common link. It is well known that lipid metabolism dysregulation may be an important etiology for PCA . 

These data are important as it suggests that we need to think more carefully about how to help patients with PCA reduce their risk of CVD. This may be particularly important in males with scarring alopecia who are at greater risk.

 

REFERENCE

Kim SR et al. Association of Primary Cicatricial Alopecia with Subsequent Cardiovascular Disease. J Invest Dermatol. 2023 Nov 19:S