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Original Investigation
January 24, 2000

Male Pattern Baldness and Coronary Heart Disease: The Physicians' Health Study

Author Affiliations

From the Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital (Drs Lotufo, Chae, Ajani, Hennekens, and Manson), the Cardiology Division, Massachusetts General Hospital (Dr Chae), and the Department of Epidemiology, Harvard School of Public Health (Drs Hennekens and Manson), Boston, Mass.

Arch Intern Med. 2000;160(2):165-171. doi:10.1001/archinte.160.2.165

Objective  To examine the association between male pattern baldness and the risk of coronary heart disease (CHD) events.

Design, Setting, and Participants  Retrospective cohort study among 22,071 US male physicians aged 40 to 84 years enrolled in the Physicians' Health Study. Of these, 19,112 were free of CHD at baseline and completed a questionnaire at the 11-year follow-up concerning their pattern of hair loss at age 45 years. Response options included no hair loss, frontal baldness only, or frontal baldness with mild, moderate, or severe vertex baldness.

Main Outcome Measures  Coronary heart disease events defined as nonfatal myocardial infarction (MI), angina pectoris, and/or coronary revascularization.

Results  During 11 years of follow-up, we documented 1446 CHD events in this cohort. Compared with men with no hair loss, those with frontal baldness had an age-adjusted relative risk (RR) of CHD of 1.09 (95% confidence interval [CI], 0.94-1.25), while those with mild, moderate, or severe vertex baldness had RRs of 1.23 (95% CI, 1.05-1.43), 1.32 (95% CI, 1.10-1.59), and 1.36 (95% CI, 1.11-1.67), respectively (P for trend, <.001). Multivariate adjustment for age, parental history of MI, height, body mass index (weight in kilograms divided by the square of the height in meters as a continuous variable), smoking, history of hypertension, diabetes, high cholesterol level, physical activity, and alcohol intake did not materially alter these associations. Results were similar when nonfatal MI, angina, and coronary revascularization were examined separately, and when events were analyzed among men older and younger than 55 years at baseline. Vertex baldness was more strongly associated with CHD risk among men with hypertension (multivariate RR, 1.79; 95% CI, 1.31-2.44) or high cholesterol levels (multivariate RR, 2.78; 95% CI, 1.09-7.12).

Conclusion  Vertex pattern baldness appears to be a marker for increased risk of CHD events, especially among men with hypertension or high cholesterol levels.