A systematic review and meta-analysis found evidence suggesting that patients with alopecia areata had an increased risk of cardiovascular disease, possibly caused by shared immunological mechanisms between the two.

Alopecia totalis (AT), a subtype of alopecia areata (AA) characterized by non-scarring alopecia, and alopecia universalis (AU), characterized by a total loss of scalp and body hair, were also found to have a more pronounced association with cardiovascular disease (CVD). 

The analysis pooled data from five observational studies—four retrospective cohorts and one matched case-control study—conducted in Taiwan, Korea, and the United States, encompassing 238,270 patients. Overall, patients with AA had a significantly higher odds ratio (OR, 1.71) than the control study for CVD . Subgroup analysis showed more pronounced associations in patients with AU or AT, (OR, 3.80), while patch-type AA, was not associated with increased risk.

No significant links were found between AA and specific cardiovascular events, such as ischemic stroke or myocardial infarction. The study authors suggested that shared immunological pathways—particularly the activation of CD8+ T cells, which contribute to both follicular immune disruption in AA and endothelial injury in CVD—may underlie the association. However, no study has verified this link and pathogenesis of different CVD subtypes varies.

“Further studies are needed with larger sample sizes and more diverse populations,” concluded Jiawei Lu, First Affiliated Hospital, Nanjing Medical University, China, and colleagues, “These studies should include standardized subtype classifications for AA and CVD, as well as perform subgroup analyses on relevant covariates, such as age, gender, smoking status, and comorbidities, to reduce heterogeneity and improve the precision of findings.”

Full disclosures are available in the published study.

Source: Frontiers in Immunology