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Circulation. 2014 Mar 4;129(9):990-8. doi: 10.1161/CIRCULATIONAHA.113.001696. Epub 2013 Dec 13.

Visible age-related signs and risk of ischemic heart disease in the general population: a prospective cohort study.

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Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark (M.C., R.F.-S.,A.T.-H.); The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark (P.S., G.B.J., B.G.N., A.T.-H.); the Department of Cardiology, Hvidovre Hospital, Hvidovre, Denmark (G.B.J.); Department of Clinical Biochemistry, Herlev Hospital, Copenhagen, Denmark (B.G.N.); and Copenhagen University Hospitals and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (M.C., R.F.-S., P.S., G.B.J., B.G.N., A.T.-H.).



Cardiovascular disease is 1 of the most common age-related diseases, and also 1 of the most common causes of death in the general population. We tested the hypothesis that visible age-related signs associate with risk of ischemic heart disease (IHD), myocardial infarction (MI), and death in the general population, independent of chronological age.


10,885 individuals aged 20 to 93 years free of IHD were followed from 1976 through 1978 until June 2011 with 100% complete follow-up. During these 35 years of follow-up, 3401 participants developed IHD and 1708 developed MI. Presence of frontoparietal baldness, crown top baldness, earlobe crease, and xanthelasmata was associated with increased risk of IHD or MI after multifactorial adjustment for chronological age and well-known cardiovascular risk factors. The risk of IHD and MI increased stepwise with increasing number of age-related signs with multifactorially adjusted hazard ratios up to 1.40 (95% confidence interval, 1.20-1.62) for IHD and 1.57 (1.28-1.93) for MI, in individuals with 3 to 4 versus no age-related signs at baseline (P for trend <0.001). In all age groups in both women and men, absolute 10-year risk of IHD and MI increased with increasing number of visible age-related signs.


Male pattern baldness, earlobe crease, and xanthelasmata-alone or in combination-associate with increased risk of ischemic heart disease and myocardial infarction independent of chronological age and other well-known cardiovascular risk factors. This is the first prospective study to show that looking old for your age is a marker of poor cardiovascular health.


aging; epidemiology; myocardial ischemia

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