Cardiac, Metabolic Morbidity Highly Prevalent in Patients with Alopecia Areata

alopecia areata beard
Young man with Alopecia areata on his beard.
The largest study examining the relationship between alopecia areata and cardiovascular disease in a US cohort is reviewed.

Cardiac and metabolic comorbidities were highly prevalent in patients with alopecia areata (AA), according to study data published in the Journal of the European Academy of Dermatology and Venereology. A cross-sectional study of patients in the United States found that AA was associated with elevated rates of all metabolic disorders and almost all cardiac conditions. Only myocardial infarction occurred at comparable rates in patients with AA and control patients.

Investigators extracted data from the Explorys electronic aggregate database, which comprises medical records data from more than 50 million patients across the United States. Patients with AA (n=33,130) were compared with patients without AA (n=57,246,350). Pearson chi-squared tests and logistic regression were used to compare patients with AA with control patients. Compared with the control group, patients with AA were more frequently women (56.0% vs 63.6%; P <.001). In addition, patients with AA were younger, with a smaller percentage older than 60 years of age (23.8% vs 31.3%) and a greater percentage younger than 50 years of age (60.7% vs 55.1%) (P <.001).

Compared with control patients, patients with AA had elevated prevalence rates of hypertension (28% vs 17.5%), obesity (18.1% vs 3%), hyperlipidemia (19.8% vs 6.6%), diabetes mellitus (11.4% vs 7.4%), metabolic syndrome (1.4% vs 0.3%), coronary artery disease (5.5% vs 1.8%), atrial fibrillation (1.7% vs 1.2%), and stroke (0.45% vs 0.31%) (all P <.001). In regression models, patients with AA had significantly increased odds for all metabolic disorders, including essential hypertension (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.80-1.88) hyperlipidemia (OR, 3.52; 95% CI, 3.43-3.62), obesity (OR, 7.1; 95% CI, 6.9-7.3), diabetes mellitus (OR, 1.61; 95% CI, 1.56-1.67), and metabolic syndrome (OR, 4.97; 95% CI, 4.53-5.44).

Elevated odds of coronary artery disease (OR, 3.13; 95% CI, 2.98-3.28), atrial fibrillation (OR, 1.4; 95% CI, 1.3-1.5), and stroke (OR, 1.45; 95% CI, 1.2-1.7) were also observed in patients with AA. The odds of myocardial infarction were not significantly elevated in patients compared with control patients (OR, 1.04; 95% CI, 0.97-1.12).

As study limitations, investigators noted that case-control matching was not performed, and adjustments could not be made for certain confounding factors, such as subtype of AA or AA severity.

These data highlight the increased burden of metabolic and cardiac morbidity in patients with AA, believe the researchers. They noted that additional studies may “confirm these findings and examine the correlation of AA severity in successful treatment to the prevalence of metabolic and cardiac conditions.” And that “Despite these limitations, to date this is the largest study examining the relationship between AA and [cardiovascular disease] in a U.S. cohort.”


Conic RRZ, Chu S, Tamashunas NL, Damiani G, Bergfeld W. Prevalence of cardiac and metabolic diseases among patients with alopecia areata [published online August 11, 2020]. J Eur Acad Dermatol Venereol. doi: 10.1111/jdv.16864