Abstract 14027: Xanthelasmata Predict Risk of Ischemic Heart Disease, Myocardial Infarction, and Overall Death in the General Population Independent of Cholesterol Levels
Objectives: Xanthelasmata are cholesterol deposits of the eyelids which like atheromas are composed of macrophages that have taken up cholesterol and become foam cells. Because 50% of individuals with xanthelasmata are normolipidemic, this suggests that xanthelasmata may be an important cutaneous marker of underlying atherosclerotic disease independent of plasma cholesterol levels. We examined this hypothesis.
Methods: Presence or absence of xanthelasmata was registered at baseline in 12,939 individuals from the Danish general population. Of these, 1,903 developed myocardial infarction (MI), 3,761 developed ischemic heart disease (IHD), and 8,663 died during up to 33 years of follow-up.
Results: The cumulative incidence of IHD and MI as a function of age was increased in individuals with xanthelasmata compared to those without, and the proportion surviving was decreased (Figure 1). Xanthelasmata predicted multivariately adjusted hazard ratios for MI and IHD of 1.51 (95% CI, 1.26-1.81) and 1.40 (95% CI, 1.22-1.60), respectively. Multivariately adjusted hazard ratio for mortality in individuals with xanthelasmata was 1.17 (95% CI, 1.06-1.28). Adjustment was for all well-known cardiovascular risk factors including plasma cholesterol levels.
Conclusion: In this prospective study of 12,939 individuals followed for up to 33 years we show that presence of xanthelasmata is an independent predictor of risk of MI, IHD, and early death. 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. In societies where other cardiovascular risk factors cannot be readily measured, presence of xanthelasmata may therefore be a useful predictor of underlying atherosclerotic disease.
- © 2010 by American Heart Association, Inc.