Comorbidities in patients with androgenetic alopecia: cardiovascular risk factors and benign prostatic hyperplasia
- Autores: Salvador Arias Santiago
- Directores de la Tesis: María Teresa Gutiérrez Salmerón (dir. tes.), Ramón Naranjo Sintes (codir. tes.), Agustín Buendia Eisman (codir. tes.)
- Lectura: En la Universidad de Granada ( España ) en 2011
- Idioma: español
- ISBN: 9788469409398
- Tribunal Calificador de la Tesis: Francisco M. Camacho Martínez (presid.), Vicente Delgado Florencio (secret.), Americo Figueiredo (voc.), Salvio Serrano Ortega (voc.), José Carlos Moreno Giménez (voc.)
- Materias:
- Enlaces
- Tesis en acceso abierto en: DIGIBUG
- Resumen
INTRODUCTION Androgenetic alopecia (AGA) is a very common hair problem in men and women. Some studies have shown a relationship between AGA and cardiovascular disease with controversy. One of the objectives of this Thesis was to analyze the presence of the cardiovascular risk factors included in the ATP-III MS criteria and the prevalence of carotid atheromatosis in male and female patients with AGA in comparison with control subjects. The other end point was to analyze the relationship between AGA in men and urinary symptoms associated with prostate growth as AGA and benign prostatic hyperplasia (BPH) are both androgen-dependent entities that respond adequately to the blocking of 5alpha-reductase.
PATIENTS This study included 300 participants, 150 with early-onset AGA (77 male and 73 female) and 150 healthy control subjects (77 male and 73 female) from the Dermatology Department.
RESULTS Metabolic syndrome and atheroma plaque were significantly more prevalent among men and women with androgenetic alopecia. Patients with AGA presented higher significant intima-media thickness and higher prevalence of hypertension, abdominal obesity, dyslipidemia and diabetes. Higher levels of serum aldosterone, insulin and acute phase reactants and lower levels of SHBG were found in AGA patients. Binary logistic regression showed that AGA was an independent risk factor of metabolic syndrome and atheroma plaque after controlling for multiple variables. Male AGA patients had significantly higher mean prostate volume, IPSS and PSA value versus controls and significantly lower maximum urinary flow. Binary logistic regression analysis showed a strong association between the presence of AGA and prostate volume >30cc after adjusting for age, maximum urinary flow, urination time and IPSS score.
DISCUSSION The relationship between androgenetic alopecia and cardiovascular disease may be explained by different mechanisms: 1-Increase in sensitivity to androgens (5alpha- reductase and DHT) at both scalp and vascular level, promoting alopecia and atheroma development. 2-The association between arterial hypertension and AGA may be a result of the high aldosterone levels found in our patients, which would explain the high blood pressure levels and were recently demonstrated to favor alopecia by stimulating mineralocorticoid receptors. 3- The hyperinsulinemia found in the patients with AGA in this study may explain the relationship between AGA and metabolic syndrome. 4- Low circulating levels of SHBG are a strong predictor of the risk of type 2 diabetes and are associated with AGA. 5- Chronic inflammation parameters in patients with AGA, as found in this study, have been cited to explain the relationship with cardiovascular disease. 6- Important role of family history in the development of alopecia and the major hereditary component of cardiovascular disease. The relationship between AGA and prostate growth-associated urinary symptoms is attributable to their pathophysiological similarity, also abdominal obesity diabetes and insulin levels have been associated with benign prostatic hyperplasia. This study suggests that early-onset AGA may be an early marker of urinary/prostatic symptomatology.
CONCLUSION The determination of metabolic syndrome, ultrasound study of the carotid arteries and urinary prostatic symptoms in patients with AGA may be useful screening methods to detect risk of developing cardiovascular disease or benign prostatic hyperplasia in patients with early-onset AGA and signal a potential opportunity for early preventive treatment.
