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 at Stanford University 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,” Stanford ophthalmology researcher Negin Yavari and colleagues write in their published paper.
“As research continues to elucidate the relationship between xanthelasma and cardio-cerebrovascular risk factors, we aimed to evaluate the association between xanthelasma and major cardio-cerebrovascular events (MACCEs) in a large study population.”
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.
frameborder=”0″ allow=”accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share” referrerpolicy=”strict-origin-when-cross-origin” allowfullscreen>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.
“Our study suggests that xanthelasma can be considered as a risk factor for future MACCEs,” write the researchers.
“Most of the patients with xanthelasma are seen by dermatologists for cosmetic reasons, while they may have undiagnosed or uncontrolled cardiovascular risk factors that contribute to this elevated risk.”
There’s no suggestion that the eyelid patches themselves are causing heart attacks or strokes, but the researchers suggest that in future, people with xanthelasma could be screened for any early heart health problems.
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.
Future research could potentially look in greater detail at the reasons why people with xanthelasma are at such a higher risk of heart attack and strokes, and ultimately give researchers a better understanding of how these problems develop.
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“Regular monitoring and management by primary care physicians can help implement preventive measures such as lifestyle modifications, anti-lipemic agents’ therapy, and hypertension [high blood pressure] control,” write the researchers.
“Thus, findings of our study highlight the importance of evaluating the patients with xanthelasma at early stages to identify and control their underlying systemic conditions, helping to prevent potential cardio-cerebrovascular events.”
The research has been published in Atherosclerosis.
This article was fact-checked by Clare Watson and edited by Clare Watson. While we pride ourselves on our process, we are only human. If you spot a mistake, please let us know.
