Xanthelasmata Identified as Independent CV Risk Factor

A large new study from Denmark finds that xanthelasmata (raised yellow patches around the eyelids) but not arcus cornae (white or grey rings around the cornea) is an independent risk factor for cardiovascular disease.

In a paper 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, CI 1.23-1.79).

Ischemic heart disease: 134 versus 226 events per 10,000 person years (multifactorial adjusted HR for xanthelasmata: 1.39, CI 1.20-1.60)

Ischemic stroke: 53 versus 64 events per 10,000 person years (multifactorial adjusted HR for xanthelasmata: 0.94, CI 0.73-1.21)

Ischemic cerebrovascular disease: 65 versus 74 events per 10,000 person years (multifactorial adjusted HR for xanthelasmata: 0.91, CI 0.72-1.15)

Total deaths: 293 versus 414 events per 10,000 person years (multifactorial adjusted HR for xanthelasmata: 1.14, 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.”

Here is the press release from the BMJ:

Yellow patches around eyelids predict risk of heart problems

Research: Xanthelasmata, arcus corneae, and ischaemic vascular disease and death in general population: prospective cohort study

Editorial: Eye markers of cardiovascular disease

Raised yellow patches of skin (xanthelasmata) around the upper or lower eyelids are markers of an individual’s increased risk of having a heart attack or suffering from heart disease, finds research published on bmj.com today.

The study, led by Professor Anne Tybjærg-Hansen at the University of Copenhagen, also concludes that white or grey rings around the cornea (arcus corneae) are not linked to an increased risk.

Previous research has established that both xanthelasmata and arcus corneae are deposits of cholesterol. However, around half of the individuals who have either or both condition will not test positively for high cholesterol in a blood test.

The researchers wanted to investigate links between xanthelasmata and/or arcus corneae and an increased risk of heart attack, heart disease, stroke, severe thickening of the arteries or premature death in the general population, as the evidence in this area is lacking.

Indeed, many patients are referred to dermatologists so that xanthelasmata can be removed.