Xanthelasmata Associated with Increased Risk of Cardiovascular Disease and Mortality Independent of Lipid Levels

DynaMed Weekly Update - Volume 6, Issue 37

Xanthelasmata (yellowish eyelid plaques) and arcus corneae (peripheral corneal opacities) are lipid deposits that have each been associated with hyperlipidemia (Circulation 1986 Jan;73(1 Pt 2):I108), but their clinical significance has been unclear. A recent large study in Denmark investigated the association between these phenomena and cardiovascular disease in a cohort of 12,745 persons aged 20-93 years (median age about 53 years) without ischemic vascular disease at baseline. Patients were followed for a mean of 22 years with 100% follow-up. Results suggest that the presence of xanthelasmata may be a simple marker to identify patients at higher risk of cardiovascular disease.

The baseline prevalence was 4.4% for xanthelasmata and 24.8% for arcus corneae. During follow-up, 14.7% had a myocardial infarction (MI), 29% developed ischemic heart disease, and 66.7% died. Risks associated with xanthelasmata and arcus corneae were evaluated in analyses adjusted for age, sex, total cholesterol, triglycerides, body mass index, hypertension, diabetes, and other cardiovascular risk factors. Presence of xanthelasmata was associated with a significantly increased risk of MI (21.8% vs. 14.4%, p < 0.05, adjusted hazard ratio [HR] 1.48), ischemic heart disease (38.5% vs. 28.6%, p < 0.05, adjusted HR 1.39), and mortality (79.2% vs. 66.2%, p < 0.05, adjusted HR 1.14) (level 1 [likely reliable] evidence). These associations remained significant in subgroup analyses stratified by 10-year age increments including patients as young as 40-49 years old. There was no significant association between xanthelasma and either ischemic stroke or ischemic cerebrovascular disease. Arcus corneae were not significantly associated with any vascular outcomes or mortality (BMJ 2011 Sep 15;343:d5497).

For more information, see the Coronary artery disease possible risk factors topic in DynaMed.