Risk of Cardiovascular Disease in Patients with Scarring Alopecia

Males with Primary Scarring Alopecia are At Particularly Increased Risk of Heart Disease

Men with primary scarring are at a higher risk of developing cardiovascular disease, coronary artery disease or stroke, according to a new study conducted by researchers from Korea. The study involved 406,016 patients, 7,986 of whom had primary scarring, 78,590 who had non-scarring, and 319,440 controls who did not have hair loss. The participants were enrolled from 2013 to 2020 and were tracked until Dec 31 2020. The study included patients with various types of scarring, including 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.

Patients with primary scarring alopecia ranged in age from 36.3 to 65.4 years, with 65.4 percent being male. The patients with PCA had more underlying disease and higher body mass index (BMI) and FSG than those in the control group.

Patients with Scarring Alopecia have increased Risk for Heart Disease

Patients with primary scarring alopecia had a higher risk of cardiovascular disease (aHR 1.18; 95% CI 1.01-1.38) and coronary heart disease (aHR 1.26; 95% CI 1.02-1.55) compared to controls after fully controlling for potential confounders (such as age, sex, household income, smoking, alcohol intake, physical activity, systolic blood pressure, fasting serum glucose, total cholesterol, and Charlson comorbidity index).

Risks for Folliculitis Decalvans Patients

Compared to controls, patients with folliculitis decalvans had a higher risk of stroke (aHR 1.39; 95% CI 1.05-1.84) and cardiovascular disease (aHR 1.29; 95% CI 1.04-1.61).

Risks for Lichen planopilaris/FFA Patients

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

Risk by Sex

When sex was taken into consideration, it was discovered that men with primary scarring alopecia were far more likely than women to experience cardiovascular disease coronary heart disease and stroke. In fact, men were primarily at risk.

Conclusion

Overall, the researchers discovered that, in comparison to controls without alopecia, patients with primary scarring alopecia had a higher risk of cardiovascular disease. In particular, among the subtypes of scarring alopecia, FD or LPP was substantially related with a higher risk of cardiovascular disease, coronary heart disease or stroke. Pseudopelade of Brocq and dissecting cellulitis did not seem to have any risk.

The precise cause of increased risk is unknown in patients with scarring alopecia. One possible common link has been suggested to be faulty lipid metabolism. It is well known that lipid metabolism dysregulation may be an important in the pathways that lead to scarring alopecia. 

These findings are significant because they imply that we should consider more carefully how to lower the risk of cardiovascular disease in patients wth scarring alopecia. This may be especially important for males who are more vulnerable.

STUDY REFERENCE

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