Eyelids Hold Clue to Heart Disease

Looking a patient square in the eye appears to give doctors an insight into the health of the patient’s heart….

Researchers said that patients who exhibit xanthelasmata — cholesterol deposits on the eyelids — are at significant increased risk of heart attacks, ischemic heart disease, and death.

In a massive observational, prospective study that spanned 33 years, researchers in Denmark found that when these yellowish lesions are observed, the risk of suffering a heart attack is increased 51% (P<0.001); the risk of suffering ischemic heart disease was increased 40% (P<0.0001); and the risk of death was increased 17% (P<0.0001) when compared with individuals who did not exhibit xanthelasmata.

Mette Christoffersen, PharmD, and a PhD candidate at Rigshospitalet, University of Copenhagen Hospital, Denmark stated that, “The prevalence of xanthelasmata in our study is 4.4%, which corresponds to 572 individuals presenting with xanthelasmata at baseline…. We found that xanthelasmata appearance was an independent risk factor for heart disease…. Because half the patients with xanthelasmata are normolipidemic, this suggests that xanthelasmata may be an important cutaneous marker of underlying atherosclerotic disease independent of plasma cholesterol levels.

“This suggests that other factors besides cholesterol levels such as capillary leakage, characteristics of macrophages or characteristics of intercellular matrix components may predispose certain individuals to both xanthelasmata and to atherosclerotic disease and early death,” she said.

Xanthelasmata are cholesterol deposits which, like atheromas, are composed of macrophages that have taken up cholesterol and have become foam cells.

They reviewed the medical records of 12,939 adults from the general Danish population. They were specifically seeking to identify individuals with xanthelasmata. Over the next 33 years of follow-up, 1,903 experienced a myocardial infarction, 3,761 developed ischemic heart disease, and 8,663 died.

Richard Stein, MD, professor of cardiology at the New York University School of Medicine, stated that, “We have long observed that patients with xanthelasmata and xanthomas on the elbows are at risk of cardiovascular events…. What was surprising about this study to me was that 50% of the patients who had xanthelasmata had what was considered normal levels of cholesterol.”

Christoffersen said most patients with xanthelasmata are not seen by cardiologists but instead go to their dermatologist. The lesions are relatively easily removed by laser surgery, she said.

Stein said that the lesions will not go away by themselves.

Christoffersen said her work may be helpful in some resource-limited settings. “In societies where other cardiovascular risk factors cannot be readily measured, presence of xanthelasmata may therefore be a useful predictor of underlying atherosclerotic disease,” she said.

• Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

• Explain that a large Danish study found an increased risk of myocardial infarction, ischemic heart disease, and death in patients with xanthelasmata followed for 33 years.

• Note that the investigators conclude that xanthelasmata may be cutaneous manifestations of atherosclerosis and do not necessarily correlate with hypercholesterolemia.

Christoffersen M, et al “Xanthelasmata predict risk of ischemic heart disease, myocardial infarction, and overall death in the general population independent of cholesterol levels” AHA 2010; Abstract 14027.