Xanthelasmata Identified as Independent CV Risk Factor

September 15th, 2011

Xanthelasmata Identified as Independent CV Risk Factor

Larry Husten, PHD

In a large new study from Denmark, xanthelasmata (raised yellow patches around the eyelids) but not arcus cornae (white or grey rings around the cornea) was found to be an independent risk factor for cardiovascular disease.

In an article in BMJ, Mette Christoffersen and colleagues report on 12,745 adults in Copenhagen without cardiovascular disease at baseline who were followed for a mean of 22 years. At baseline, 4.4% had xanthelasmata and 24.8% had arcus corneae. Here are the main results, comparing the group without xanthelasmata to the group with xanthelasmata:

MI: 65 events versus 121 events per 10,000 person-years (multifactorial-adjusted HR for xanthelasmata, 1.48; 95% CI, 1.23-1.79).
Ischemic heart disease: 134 versus 226 events per 10,000 person-years (multifactorial-adjusted HR for xanthelasmata, 1.39; 95% CI, 1.20-1.60)
Ischemic stroke: 53 versus 64 events per 10,000 person-years (multifactorial-adjusted HR for xanthelasmata, 0.94; 95% CI, 0.73-1.21)
Ischemic cerebrovascular disease: 65 versus 74 events per 10,000 person-years (multifactorial-adjusted HR for xanthelasmata, 0.91; 95% CI, 0.72-1.15)
Total deaths: 293 versus 414 events per 10,000 person-years (multifactorial-adjusted HR for xanthelasmata, 1.14; 95% CI, 1.04-1.26)

The authors write that their results “suggest that xanthelasmata are a cutaneous marker of atherosclerosis independent of lipid concentrations and thus should be considered in clinical practice as an independent and additional risk factor for myocardial infarction and ischaemic heart disease.” They say the findings may be especially useful in places with limited access to laboratories.

In an accompanying editorial, Antonio Fernandez and Paul Thompson write that people with xanthelasmata “may have an enhanced biological propensity to deposition of cholesterol in vascular and soft tissue, which is not fully represented by their fasting lipid profiles. Because xanthelasmata are composed of foam cells similar to those present in atherosclerotic plaque, they may be a better marker than arcus corneae of the intra-arterial atherosclerotic process.” Therefore, they conclude, these patients “may therefore require more aggressive management of risk factors.”

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September 15th, 2011