Xanthelasma and its association with developing major cardio-cerebrovascular events

Sometimes you can see a warning sign of heart attack and stroke on your face first!

Xanthelasmas are yellowish papules or plaques caused by the deposition of lipid on or around the eyelids. The lesions are relatively rare, with an incidence of 1.1% in women and 0.3% in men. Lesions typically appear between 40 and 60 years but may appear at younger ages as a sign of a familial dyslipoproteinemia. Approximately 50% of patients with xanthelasmas have abnormal cholesterol or triglyceride levels, and these lesions have been associated with hypothyroidism, cirrhosis, and nephrotic syndrome. Therefore, systemic work-up is indicated in these patients. [1]

These whitish-yellow or cream patches around your eyes

Image Source: webeye.ophth.uiowa.edu

Atherosclerosis, the accumulation of fatty plaques in the arteries that causes restricted blood flow, is responsible for most heart attacks and strokes – but it often builds up slowly and silently, without symptoms, before causing a major medical emergency.

That's why researchers are looking for warning signs of atherosclerosis that might help doctors spot it earlier.

A new study, published in Atherosclerosis, looks at a condition called xanthelasma, where yellow patches appear around the eyes.

Those patches puff up when immune cells called macrophages get stuffed with cholesterol and other fats. The condition is often (but not always) associated with higher cholesterol in the blood, too.

As fatty clumps also play a role in atherosclerosis, researchers thought there might be a link.
A few studies have supported the association between xanthelasma and an increased risk of cardiovascular events, while others debate that it may not be an independent risk factor once traditional risk factors are accounted for.
The study analyzed health data from 17,925 people diagnosed with xanthelasma and the same number of matched controls – people with presbyopia, a condition that leads to farsightedness, chosen because it would have involved an eye examination, ensuring the controls didn't have xanthelasma.
Across the first year of data, 1 percent of those with xanthelasma (178 patients) suffered a heart attack compared to 0.35 percent (or 63) of the controls.

For strokes, the respective figures were 0.95 percent and 0.3 percent, and for transient ischemic attack (TIA) or a 'mini-stroke', it was 0.6 percent and 0.19 percent.
Those are all low percentages, but the risk was several times larger for the xanthelasma group.

The gap between the two groups narrowed slightly over time, but at the 5- and 10-year time points, the risk was still substantially higher for those with xanthelasma.

Xanthelasma is associated with higher short- and long-term incidence of MACCEs up to 10 years, highlighting its value as a clinical marker for cardiocerebrovascular risk stratification and preventive management," write the researchers.

Incidence rates of these cardiac events were similar in the xanthelasma group whether or not they had abnormally high levels of fat in their blood – suggesting this isn't the only underlying factor at play.

While the pale, puffy patches that characterize xanthelasma are seen as harmless in themselves, the findings are more evidence that they could signify something else, and perhaps future cardiovascular problems.
This new study study suggests that xanthelasma can be considered as a risk factor for future MACCEs.
Xanthelasma patches are easy for doctors to spot, and for these people at least, may be a useful warning sign so that lifestyle changes or medications could be put in place early – before MACCEs are triggered.

Research paper:

https://www.atherosclerosis-journal.com/article/S0021-9150(26)00013-4/fulltext

1. Rohrich, R.J., J.E. Janis, and P.H. Pownell, Xanthelasma palpebrarum: a review and current management principles. Plast Reconstr Surg, 2002. 110(5): p. 1310-4.