Xanthelasmata, patches of yellow skin around the lower or upper eyelids can mean that the person who has them has a greater risk of developing heart disease or having a heart attack, researchers from the University of Copenhagen reported in the BMJ (British Medical Journal).

Xanthelasmata is the plural of xanthelasma, also called xanthelasma palpebrarum. They are sharply demarcated yellowish collections of cholesterol below the skin, typically on the eyelids or around them. They are neither painful nor harmful, although they can be disfiguring and are easily removed. Xanthelasmata are more common among individuals of Asian and Mediterranean origin.

Professor Anne Tybjærg-Hansen and team also reported that arcus corneae, grey or white rings around the cornea, are not associated with greater heart attack or heart disease risk.


Xanthelasma

Prior studies had demonstrated that arcus corneae and xanthelasmata are deposits of cholesterol. Half of all patients who have rings around the cornea or xanthelasmata have high blood cholesterol levels. The researchers stress that the other half don't.

Tybjærg-Hansen and team set out to determine whether xanthelasmata and/or arcus corneae might be markers for certain cardiovascular conditions, such as stroke, severe thickening of the arteries, heart attack, or premature death in general.

The authors wrote that a considerable number of patients are referred by their primary care physician to a dermatologists to have the yellow patches removed.

The researchers gathered data on 12,745 people who had taken part in the Copenhagen City Heart Study. They were between 20 and 93 years old. None of them had any type of heart condition at the beginning of the study. They were regularly and thoroughly followed up from 1976 to 2009.

4.4% (563) of them had xanthelasmata and 24.8% (3,159) had arcus corneae at the start of the study.

During the three-decade follow up period, 3,699 developed some kind of heart disease, 1,872 of them had a heart attack, 1,498 had a stroke, 1,815 developed cerebrovascular disease, and 8,507 died.

The researchers found that those with xanthelasmata had a considerably higher chance of developing heart disease or dying within ten years compared to other individuals. The risk remained after taking into account other factors that could have influenced the results, such as obesity, hypertension, cholesterol levels, gender, and smoking status and/or history.

The closest link between xanthelasmata and heart disease and heart attack risk was found among males between 70 and 79 years of age. 41% of males with no xanthelasmata within that age range had a risk of developing the mentioned diseases and conditions, compared with 53% among those with xanthelasmata.

Among females of all ages, the difference in risk was 35% compared to 27%.

However, arcus corneae was found not to be a risk predictor of heart disease or heart attack.

The researchers say that doctors should use the presence of xanthelasmata when diagnosing heart disease and associated conditions. They add that where access to laboratory facilities are difficult, looking out for xanthelasmata could be especially useful for doctors.

In an Accompanying Editorial, the authors write that during a comprehensive examination, xanthelasmata could be used by primary care physicians to help identify those at greater risk of heart attack and heart disease.

Written by Christian Nordqvist