Level 1: Likely reliable evidence

Xanthelasmata (yellowish eyelid plaques) and arcus 
corneae (peripheral corneal opacities) are lipid deposits that have been associated with hyperlipidemia.1 A recent study investigated these phenomena in connection with cardiovascular disease in a cohort of 12,745 persons aged 20-93 years (median age about 53 years) without ischemic vascular disease at baseline. Patients were followed for a mean of 
22 years with 100% follow-up. Xanthelasmata may be a marker for patients at higher risk of cardiovascular disease.

The baseline prevalence was 4.4% for xanthelasmata and 24.8% for arcus corneae. During follow-up, 14.7% had a MI, 29% developed ischemic heart disease, and 66.7% died. Risks associated with xanthelasmata and arcus corneae were evaluated in analyses adjusted for age, sex, total cholesterol, triglycerides, body mass index, hypertension, diabetes, and other cardiovascular risk factors.

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Presence of xanthelasmata was associated with a significantly increased risk of MI (21.8% vs. 14.4%, P<0.05, adjusted hazard ratio [HR]=1.48), ischemic heart disease (38.5% vs. 28.6%, P<0.05, adjusted HR=1.39), and mortality (79.2% vs. 66.2%, P<0.05, adjusted HR=1.14). These associations remained significant in subgroup analyses stratified by 10-year age increments including patients as young as 40-49 years old. There was no significant association between xanthelasmata and either ischemic stroke or ischemic cerebrovascular disease. Arcus corneae were not significantly associated with any vascular outcomes or mortality.

1. Circulation.1986;73:I108-I118

2. BMJ. 2011;343:d5497