Eyelid Plaque May Increase Risk for Severe Atherosclerosis

In an accompanying editorial, Dr. Antonio B. Fernandez and Dr. Paul D. Thompson discussed the clinical relevance of the findings.

"In the linked prospective cohort study, Christoffersen and colleagues assess whether xanthelasmata and arcus corneae, individually and combined, predict risk of ischemic vascular disease and death in the general population," Dr. Fernandez and Dr. Thompson wrote. There are some good reasons for suspecting such a link (BMJ 2011;343:d5304).

"Both xanthelasmata and arcus corneae are composed of cholesteryl esters similar to those found in serum low-density lipoprotein cholesterol and very low-density lipoprotein cholesterol. They share similar risk factors and have pathophysiological similarities with atherosclerosis," they noted.

Importantly, the results of this study confirm "that xanthelasmata are an important predictor of cardiovascular disease events and death beyond [their] known association with hyperlipidemia."

However, "what do these results mean in practice?" they asked. "Overall, the evidence highlights the importance of a comprehensive physical examination and suggests that xanthelasmata could be used by general clinicians to help identify people at higher risk of cardiovascular disease. These people may have an enhanced biological propensity to deposition of cholesterol in vascular and soft tissue, which is not fully represented by their fasting lipid profiles. ... Patients with xanthelasmata may therefore require more aggressive management of risk factors," they concluded.

Dr. Fernandez is a clinical cardiology fellow at the Alpert Medical School at Brown University in Providence, R.I. Dr. Thompson is the director of cardiology at Hartford (Conn.) Hospital. Dr. Thompson reported significant financial relationships with several pharmaceutical companies.