Background: Scarcely ever studied, only one prospective cohort study recently reported on associations between male pattern baldness, earlobe crease and xanthelasma, alone or in combination, and an increased risk of ischemic heart disease and myocardial infarction independently of chronological age and other classical cardiovascular risk factors.
Purpose: To examine the association of forehead wrinkles with all-cause and cardiovascular mortality.
Methods: From VISAT cohort, 3,221 French volunteer workers aged 32, 42, 52 and 62 years at baseline were recruited during medical examination carried out by occupational physicians. Forehead wrinkles were clinically assessed by investigators with the support of a set of graduated photos ranging from 0 (reference) to 3 (numerous and deep wrinkles). Statistical analyses were performed among participants without prevalent pathologies as cancers, cardiovascular, liver and kidney diseases. Crude and adjusted cox proportional analyses were used to determine the association between forehead wrinkles and all-cause and cardiovascular mortality over 20-year follow-up.
Results: In the course of the 19.5 year median follow-up, 7.2% (233) of subjects died; 2.1% in subjects with no wrinkle (score 0), 6.6% in score 1 and 15.2% in score 2&3 (p for trend <0.001). The Kaplan-Meier survival curve analysis showed a significant difference according to wrinkle scores (Log-rank test, p<0.001) with a higher pejorative temporal evolution in subjects with score 2&3. Using crude analyses and compared to wrinkle score 0, the risks of all-cause mortality death [Hazard Ratio (95% confidence intervals)] were: 3.05 (1.80–5.16) and 6.09 (3.54–10.5) in score 1 and score 2&3 respectively but became non-significant after multivariate adjustments. Unadjusted analysis showed increased risks of cardiovascular mortality when scores of forehead wrinkles increased: 4.94 (0.57–42.7) and 10.2 (1.09–95.7) in score 1 and 2&3 respectively, (p for trend<0.001). Forehead wrinkles remained significantly associated with cardiovascular mortality after multivariate adjustment on age, gender, education, smoking, systolic blood pressure, heart rate, diabetes and dyslipidemia. HRs were 5.69 (0.68–47.5) and 9.64 (1.09–85.3) for score 1 and score 2&3 respectively (p for trend 0.01).
Conclusion: In a working population, the number and the depth of forehead wrinkles were associated with cardiovascular mortality regardless chronological age and classical cardiovascular risk factors.