Monday, August 22, 2011

The past matters when it comes to heart disease

Many people think that exercising is important when it comes to protecting your heart. They are right. However, exercise is not a magical cure for heart disease. People who exercise can still have heart disease. Unfortunately, this is a fact that many patients like to cite whenever they try to justify their unwillingness to comply to prescribed exercise.

Marathon runners can suffer from a heart attack, but that does not mean that exercise is useless. In fact, those unfortunate marathon runners would most likely have had their heart attacks much sooner if they were not exercising regularly. Regular exercise also results in improving your cardiac reserve, meaning if you survive a heart attack your heart will continue to function more effectively than it would if had you not been exercising regularly.

One reason active people still suffer from heart disease is that family and personal history still have a major role in heart health. If you come from a family where your parents and grand parents have all had heart attacks by the time they were 50, you are automatically at an increased risk for heart disease...even if you exercise every day. Again, exercise is still beneficial to your cardiovascular system, but it will not necessarily stop you from ever getting the heart attack that your genetics has preordained for you. Personal history is important too because if you have been significantly overweight from the time you were 5 until you were 35, you are still at risk for heart disease even if you suddenly train your way up to running marathons. Those 30 years of unhealthy living may have resulted in atherosclerotic plaques forming in your blood vessels that can rupture to cause a heart attack in your future and, unfortunately, they do not just suddenly disappear if you decide to become more active.

Heart disease is complex and there are many different factors that can put you at risk for a cardiovascular event. The point I am trying to make here is that exercising within reasonable limits will almost always decrease your risk for a cardiac event; however, exercising cannot guarantee that your heart will not fail you. So please, do not decide to ignore your doctor's request for you to be more active because you read about a man who had a heart attack while going for a jog. Instead, just mention your concerns and keep asking questions until your physician gives you an explanation that satisfies you.

Sunday, August 21, 2011

Treatments for balding

The medical term for "male pattern baldness" is androgenetic allopecia. It is the most common type of hair loss and, colloquial name aside, it can affect both men and women. In men, androgenetic allopecia starts with balding on the crown of the head and makes an "M" pattern along the frontal hair line. In women, the hair loss is more generalized and diffuse, but the frontal hair line is usually spared.

Why does hair loss happen? The current theory describing the pathogenesis of androgenetic allopecia attributes hair loss to dihydrotestosterone receptors on hair follicles. When activated by dihydrotestosterone, these receptors cause the hair follicle to shrink and eventually the hair becomes too thin to pierce through the scalp, resulting in apparent hair loss. One enzyme involved in this pathogenesis is alpha-5-reductase, which converts testosterone and other androgens to dihydrotestosterone.

How do we treat androgenetic allopecia? Two of the most popular treatments, that are supported by research and do not involve surgery, are using rogaine (topical minoxidil) and propecia (oral finasteride).

Minoxidil is nice because it is a topical solution, meaning you spread it over your scalp and very little of it gets absorbed by the rest of your body. Unfortunately, we aren't exactly sure how minoxidil actually works; however, studies do support that it does actually restore hair growth in both men and women. Minoxidil's most common side effect is causing a contact dermatitis.

Finasteride is taken in pill form and works by inhibiting alpha-5-reductase, which reduces the amount of testosterone that is converted to dihydrotestosterone. Studies have shown that finasteride works at restoring hair growth in men and that it is significantly better than 2% concentrations of minoxidil; however, finasteride does not appear to help women with androgenetic allopecia. Rare, but concerning, side effects of finasteride include decreased libido and ejaculatory or erectile dysfunction. Health Canada recently released a statment about finasteride being associated with rare cases of male breast cancer. However, evidence suggests that all of these side effects are much more common in the 5mg formulation of finasteride, which is used to treat prostate disease. Androgenetic allopecia is usually treated with 1mg doses.

As with every treatment in medicine, there are obvious risks and side effects with any treatment, even for more cosmetic issues like androgenetic allopecia. We also do not have a lot of data regarding the long term affects for using the two therapies I discussed in this post. So make sure you take the time to assess how much risk you are willing to take to treat your hair loss before you begin taking either finasteride or minoxidil.

UpToDate has a great article on androgenetic allopecia, which was my major resource for this post.