Dr Margaret answers e-mailers' embarrassing problems in this biweekly problem page.

Dear Dr Margaret
I seem to be going bald. According to your website, this means I'm more likely to have a heart attack. If I take a drug to prevent hair loss, will it reduce my risk of a heart attack?

Dr Margaret replies
This is an interesting question, and I'll try to answer you as fully as I can. I'll split my answer into the following sections. Anyone new to the site and interested in this topic might also like to read what I've written in the main section on baldness.

Scientific research
Firstly, let's look at the connection between baldness and heart attacks. Several studies over the past few years have shown a link. The most important was the Physicians Health Study, a study of 19 000 male American doctors (published last year in Archives of Internal Medicine). The researchers already had data on the doctors' heart problems (such as heart attacks and angina). The researchers then sent the doctors diagrams of balding heads, and asked which picture most resembled their hair pattern when they were 45 years of age. Some of the pictures showed a receding hairline, and others showed loss of hair at the top of the head.

The results were interesting. The men with a receding hairline at age 45 had a slight increase (9%) in the risk of heart problems. Those with a smallish bald patch on the top of the head had a 23% greater likelihood of coronary heart disease than non-bald men. Those who had lost most of their hair from the top of their head by the age of 45 had a 36% greater likelihood. The risk was worse if the men also had high blood pressure or high cholesterol levels. Men who were bald on the top of their heads and had a high cholesterol increased their risk by three times, while baldness with high blood pressure almost doubled the risk.

Why the link?
I cannot explain this link, because it is not really understood. It seems that various conditions that we used to think of as separate - such as high blood pressure, high cholesterol and other blood lipids, obesity, diabetes, polycystic ovary syndrome in women, baldness in youngish men - are somehow connected. So if you suffer from one, you may be at risk of some of the others, and overall you have an increased chance of coronary heart disease.

The reason is partly the way in which the various cells of the body interact with hormones such as insulin and testosterone. Insulin's job is to help the cells of the body absorb glucose from the blood. Recent research (published this year in the Lancet) shows that, in bald men, insulin is not as effective as it should be ('insulin resistance'). The body compensates by producing extra insulin, and these high insulin levels probably cause the coronary heart disease. There is a lot of research in this area at the moment, so it should all become clearer over the next few years.

What you can do
Of course, the baldness is not directly causing the coronary heart problems. It is just a signal that your body metabolism makes you slightly more at risk of heart problems than some other people. And I haven't seen any evidence suggesting that taking a drug for baldness, such as finasteride, will protect against coronary artery disease.

In fact, your hair loss may be a blessing in disguise, because it is giving you an early warning of a possible problem - and there is ample time and lots of things you can do to keep your coronary arteries healthy.

Firstly, the link is really between baldness on top of the head that occurs in men in or before their 40s. (Hair that starts to thin when you are over 55 is a normal part of the ageing process, and hasn't been linked with an increased risk of heart disease).

Secondly, ask your GP to check your blood pressure, and to do a simple fasting blood test for diabetes. Your GP might also wish to check your cholesterol levels.

Thirdly, check your lifestyle. If you are overweight, lose some - even losing a few pounds will reduce your risks. Become a bit more active. And if you are a smoker, stop straight away - this is probably the single most important thing you can do to improve your health.

Any more questions?
If you have any questions or comments relating to this article, please e-mail them to info@healthpress.co.uk. Dr Margaret will try to answer e-mailers' questions here, but she cannot enter into personal consultations.