Severity of Androgenetic Alopecia and its Association with Serum Lipid Levels: A Case Control Study from a Tertiary Care Center

Dear Sir, Androgenetic alopecia (AGA) is a hereditary and androgen-dependent progressive patterned hair loss from the scalp affecting both males and females.[1] Various studies have shown a significant association between AGA and cardiovascular risk factors such as hyperlipidemia.[2] The primary objective of this study was to relate the serum lipid profile levels to severity of AGA. This is an 18-month case–control study done at a tertiary care center including all the cases of AGA above 18 years of age after the Ethical Committee clearance. The control group included gender- and sex-matched cases above 18 years of age without AGA. Every patient was subjected to thorough general, physical, systemic, and dermatological examination and AGA severity was classified according to Norwood Hamilton (in males) and Ludwig (in females). Serum fasting lipid profile: Total cholesterol, triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were done for all the cases and the controls. Qualitative data were expressed in proportion or percentage. The quantitative variable was expressed as mean and standard deviation. To assess the significance of elevated serum lipid profile and severity of AGA, the Chi-square test and Fischer’s exact test was employed and a “P” <0.05 was considered statistically significant. This case–control study had 65 patients in the case group (n = 65) and 65 age- and sex-matched individuals in the control group. The mean age of the cases was 27.49 ± 7.4 years and 27.60 ± 7.2 years in the control group. There were 45 males (69%) and 20 females (31%), with a male/female ratio of 2.25:1 in both the case and control groups. The most common grade of AGA in males was Grade III (29.5%) [Figure 1] and in females Grade 1 (57.1%) [Figure 2]. The serum lipid profile levels in association with severity of AGA are given in Table 1.Figure 1: Grading of androgenetic alopecia in malesFigure 2: Grading of androgenetic alopecia in femalesTable 1: Serum lipid profile in relation to severity of androgenetic alopecia in males and femalesThis case–control study focussed on the severity of AGA with serum lipid levels. Smoking, increased body mass index, abdominal obesity, hypertension, diabetes, and hyperlipidemia are the recognized universal risk factors for cardiovascular disease. In the present study, cases had significantly increased levels of total cholesterol (“P” =0.001), triglycerides (“P” =0.001), and LDL (“P” =0.001) levels compared to controls. There was significant association between severity of AGA and levels of total cholesterol (“P” =0.0001) and triglycerides (“P” =0.003) in males, but not in females [Table 1]. There was no significance between severity of AGA and LDL and HDL levels. These findings were almost similar to study by Sharma and Jindal, Sasmaz et al. and Chakrabarty et al. which showed significantly elevated levels of total cholesterol, triglycerides, LDL, and significantly decreased levels of HDL in cases compared to controls.[3-5] Hence, based on these findings, it can be suggested that patients with AGA should be screened for dyslipidemia which is an important cardiovascular risk factor. A small sample size is the limitation of this study. In conclusion, this study showed a significant relation between serum cholesterol and triglyceride levels and severity of AGA. Hence, it is mandatory to screen AGA patients for dyslipidemia to identify the cardiovascular risk factors. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.