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28-09-2011 | Article

Xanthelasmata predict cardiovascular risk


Free abstract

MedWire News: Xanthelasmata palpebrarum - sharply demarcated, yellowish flat plaques on the upper or lower eyelids - are associated with an increased risk for myocardial infarction, ischemic heart disease, and death, say researchers.

By contrast, arcus corneae - grey-white-yellowish opacity located near the periphery of the cornea - is not an important independent predictor of risk, they say.

Previous studies have shown that xanthelasmata and arcus corneae are associated with increased concentrations of plasma total or low-density lipoprotein cholesterol, decreased concentrations of high-density lipoprotein cholesterol, or both. However, few studies have examined potential associations between xanthelasmata or arcus corneae and risk for myocardial infarction and ischemic heart disease.

To investigate further, Anne Tybjaerg-Hansen (Bispebjerg Hospital, Copenhagen, Denmark) and co-authors prospectively analyzed data from 12,745 participants of the Copenhagen City Heart Study who were aged 20-93 years at baseline and free from ischemic vascular disease.

At the beginning of the study, 4.4% (n=563) of the participants had xanthelasmata and 24.8% (n=3159) had arcus corneae.

During the mean follow-up period of 22 years, 1872 participants developed myocardial infarction, 3699 developed ischemic heart disease, 1498 developed ischemic stroke, 1815 developed ischemic cerebrovascular disease, and 8507 died.

Compared with those who did not present with xanthelasmata, those who did had a 47% increased risk for myocardial infarction, a 56% increased risk for ischemic heart disease, and a 9% increased risk for death. Furthermore, the cumulative incidence of myocardial infarction, ischemic heart disease, and death was significantly higher in people with versus without xanthelasmata.

Writing in the BMJ, the authors say that the highest risks were found in men between the ages of 70 and 79 years; those with xanthelasmata had a 53% increased risk compared with the 41% risk for men without the condition. The corresponding risks for women were 35% and 27%.

Furthermore, the odds for developing severe atherosclerosis were 69% higher in those with compared with those without xanthelasmata.

The increased risk for myocardial infarction, ischemic heart disease, and death associated with xanthelasmata was independent of well-known cardiovascular risk factors, such as plasma cholesterol and triglyceride concentrations, the researchers note.

By contrast, arcus corneae was not associated with any of the outcomes assessed.

The team concludes: "The results from this study 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 ischemic heart disease."

By Nikki Withers