Patients with alopecia areata (AA) face an increased risk of developing cardiovascular disease, a new meta-analysis found.1 The findings add weight to the theory that there is an underappreciated interplay between AA and cardiovascular disease. The new analysis was published in Frontiers in Immunology.
AA has already been linked with several comorbidities, including inflammatory and gastrointestinal diseases, the study authors noted. Previous research has suggested that there might likewise be an association between cardiovascular disease and AA.
The authors performed a systematic review and meta-analysis of studies examining cardiovascular disease and alopecia areata. | Image credit: Thirakun – stock.adobe.com
A 2021 study showed significant associations between cardiovascular, atherosclerosis, and immune pathways and Severity of Alopecia Tool (SALT) scores in patients with AA.2 A subsequent study showed that levels of a key atherosclerosis biomarker were higher in patients with more severe AA.3
Still, the authors said the mechanistic links between AA and cardiovascular disease are not well understood.1 Moreover, they said the issue of a relationship between AA and cardiovascular disease remains controversial.
In an effort to clarify the issue, the authors performed a systematic review and meta-analysis of studies examining cardiovascular disease and AA. They searched 4 academic databases looking for studies on the relationship between AA and cardiovascular disease. They found a total of 5 studies, which together represented 238,270 patients with AA from three countries.
The investigators found that patients with AA were indeed at a higher risk of cardiovascular disease, with an odds ratio of 1.71 for cardiovascular disease (95% CI, 1.0-2.92; P < .01) compared with controls without AA.
However, they found that the correlation was complicated; it depended heavily on the AA subtype. The data showed that patients with alopecia totalis or alopecia universalis had a substantially higher risk of cardiovascular disease (OR, 3.80; 95% CI, 1.65-8.73; P < .01). However, the data failed to show a correlation between patch-type AA and cardiovascular disease, nor with ischemic stroke or myocardial infarction.
The investigators said they believe their study is the first meta-analysis to systematically study links between AA and cardiovascular disease. They said the findings underscore the benefits of early intervention in AA.
“Given the higher immune alterations of AA scalp and the correlation between its clinical severity and biomarkers of immune and cardiovascular dysregulation, early systemic treatments are highly recommended in patients with significant AA involvement,” they wrote.
The authors cited several possible reasons for the associations. They noted that both AA and cardiovascular disease share common immunological mechanisms and that immune dysregulation in follicular air epithelium beyond the scalp may contribute to circulatory abnormalities in patients. Additionally, they noted that CD8+ T cells play a key role in both AA and cardiovascular disease.
Still, the authors said there is a limited number of published studies on such associations, so they said additional research is needed. They also noted that the available studies were based on patients from the United States, Taiwan, and Korea, and so they may not be representative of all patients. In addition, they noted that the diagnosis of different types of AA is reliant upon the judgment of dermatologists, and thus there may be subjective variability in subtype classification.
Still, the authors concluded the analysis supports the idea that people with AA are at an elevated risk of cardiovascular disease, even if the exact mechanisms and nuances of the association remain unclear.
References
1. Lu J, Cao X, Feng Y, Yu Y, Lu Y. Association between alopecia areata and cardiovascular disease: a systematic review and meta-analysis. Front Immunol. Published August 6, 2025. doi:10.3389/fimmu.2025.1643709.
2. Glickman JW, Dubin C, Renert-Yuval Y, et al. Cross-sectional study of blood biomarkers of patients with moderate to severe alopecia areata reveals systemic immune and cardiovascular biomarker dysregulation. J Am Acad Dermatol. 2021;84(2):370-380. doi:10.1016/j.jaad.2020.04.138
3. Waśkiel-Burnat A, Niemczyk A, Blicharz L, et al. Chemokine C-C motif ligand 7 (CCL7), a biomarker of atherosclerosis, is associated with the severity of alopecia areata: a preliminary study. J Clin Med. 2021;10(22):5418. doi:10.3390/jcm10225418