Xanthelasma Linked With MI and Ischemic Heart Disease

November 23, 2010

November 23, 2010 (Chicago, Illinois) — Xanthelasma, a yellowish collection of fatty cholesterol around the eyelids, is associated with a significant risk of ischemic heart disease and MI, even after adjustment for traditional cardiovascular risk factors, including plasma lipid levels, a new study reveals. The condition, usually seen by family doctors and dermatologists, should serve as a marker of underlying atherosclerotic disease, even in patients with normal cholesterol levels, say researchers.


"Most patients come to the dermatologist because they want these xanthelasmas removed for cosmetic reasons, and some dermatologists might refer them on to other specialists because of their increased risk of cardiovascular disease, but that's not always the case," lead investigator Dr Mette Christoffersen (Copenhagen University Hospital, Denmark) told heartwire .

Presenting the results of the study last week during the American Heart Association (AHA) 2010 Scientific Sessions, Christoffersen explained that xanthelasmas are composed of macrophages that have taken up cholesterol and become foam cells. Smaller studies have been performed, she said, with these showing an association between xanthelasma and cardiovascular disease, while others have shown that the mechanisms behind the formation of xanthomas are similar to the formation of cholesterol within the artery. As a result, the presence of xanthelasma might be a possible cutaneous marker of underlying atherosclerotic disease, she said.

In this large Danish analysis, the presence or absence of xanthelasma was registered at baseline in 12 939 individuals in the general population. Of these individuals, 1903 had an MI and 3761 developed ischemic heart disease, while more than 8600 died over the course of the 33-year follow-up period.

After adjustment for other risk factors, including LDL-cholesterol levels, the risk of MI and ischemic heart disease was 51% and 40% higher, respectively, among individuals with identified xanthelasma when compared with individuals without the disorder. Also, the presence of xanthelasma was associated with a significant 17% greater risk of total mortality when compared with those without xanthelasma.

To heartwire , Christoffersen said that almost 50% of individuals with xanthelasmas have normal cholesterol levels. This suggests that other factors, such as capillary leakage, the characteristics of macrophages, or the characteristics of the intercellular matrix components, might predispose individuals to xanthelasma and MI, ischemic heart disease, and early death. The researchers suggest that in developing nations, where cholesterol levels might not be readily measured, the skin condition could be used as a warning signal of underlying cardiovascular disease.

The authors report no conflicts of interest.


The complete contents of Heartwire , a professional news service of WebMD, can be found at www.theheart.org, a Web site for cardiovascular healthcare professionals.


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