Yellowish patches around the eyelids, known as xanthelasma, may be associated with a substantially higher risk of heart attack and stroke, according to a large study. The findings suggest that a condition often regarded mainly as a cosmetic concern could also provide a visible clue to cardiovascular risk.
Atherosclerosis, the gradual accumulation of fatty plaques inside arteries, contributes to most heart attacks and many ischemic strokes and can develop for years without obvious symptoms. Researchers have therefore investigated whether easily recognizable physical signs could help identify people who may warrant closer cardiovascular assessment.
What xanthelasma may reveal about cardiovascular risk
Xanthelasma typically appears as pale yellow, slightly raised plaques on or around the eyelids. The lesions contain lipid-laden cells, including macrophages that have accumulated cholesterol and other fats.
Because xanthelasma involves abnormal lipid deposition, scientists at Stanford University investigated whether its presence was associated with subsequent cardiovascular and cerebrovascular events. Previous, smaller studies had suggested a possible connection, although findings were inconsistent.
The researchers examined whether people diagnosed with xanthelasma experienced heart attacks, strokes and transient ischemic attacks more frequently than a comparison group over several years.
Inside the long-term study
The team analyzed health records from 17,925 people diagnosed with xanthelasma and matched them with an equal number of individuals with presbyopia, the age-related loss of near focusing ability. Using patients who had undergone eye examinations provided a comparison group receiving similar ophthalmic care.
During the first year, approximately 1% of people with xanthelasma experienced a heart attack, compared with 0.35% of controls. Stroke occurred in approximately 0.95% versus 0.3%, while transient ischemic attack occurred in 0.6% versus 0.19%.
Although the absolute event rates were relatively low, the differences between groups were substantial. The associations became smaller over time but reportedly remained present at five and ten years.
Because the research was observational and based on health records, it cannot establish that xanthelasma itself causes cardiovascular events. Instead, the findings indicate that people with the condition had higher rates of these outcomes.
Risk beyond standard cholesterol tests
Notably, cardiovascular event rates among people with xanthelasma appeared elevated regardless of whether clearly abnormal blood lipid levels were documented.
This suggests that xanthelasma may provide information not completely captured by a conventional lipid measurement. However, the study does not establish that eyelid deposits directly correspond to the amount of atherosclerosis inside a person’s arteries.
The lesions themselves are not thought to cause heart attacks or strokes. Rather, xanthelasma may identify people who share underlying metabolic, cardiovascular or other risk factors.
The relationship could also involve factors that are difficult to capture fully in health-record studies, including differences in health conditions, medications, lifestyle and healthcare use.
Implications for screening and prevention
People frequently seek treatment for xanthelasma because of its appearance, meaning the condition may first be noticed by dermatologists, ophthalmologists or primary-care clinicians.
Its presence could provide an opportunity to review established cardiovascular risk factors, including cholesterol levels, blood pressure, diabetes and smoking. Lifestyle factors relevant to cardiovascular health can also be considered as part of an individual risk assessment.
However, xanthelasma alone does not mean that someone needs cholesterol-lowering or blood-pressure medication. Such treatment decisions depend on overall cardiovascular risk, medical history, laboratory findings and clinical guidelines.
It also remains unclear whether formally adding xanthelasma to existing cardiovascular risk-prediction tools would improve their ability to identify people who will later experience heart attacks or strokes.
What comes next for research?
Future research could investigate why xanthelasma is associated with cardiovascular events and whether genetics, lipid metabolism, inflammation or other metabolic factors help explain the relationship.
Studies could also determine whether xanthelasma provides useful predictive information beyond established cardiovascular risk factors when those factors are measured comprehensively.
Another question is whether treating cardiovascular risk factors influences the development or recurrence of the eyelid lesions. Removing xanthelasma for cosmetic reasons should not be assumed to reduce cardiovascular risk, because eliminating the visible deposit does not necessarily alter the processes associated with its formation.
For people who notice new yellowish plaques around their eyelids, the finding is not a reason to assume that a heart attack or stroke is imminent. Medical assessment can first determine whether the lesions are actually xanthelasma and review any relevant cardiovascular risk factors.
The study adds to evidence that xanthelasma may be more than a cosmetic finding. It could serve as an easily visible marker associated with cardiovascular risk, while further research is needed to determine how much additional predictive information it provides beyond established clinical measures.
