Correlating corneal arcus with atherosclerosis in familial hypercholesterolemia

Loren A Zech Jr¹^,2 and Jeffery M Hoeg^{^}¹

¹Molecular Disease Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Building 10/Room 7N115, 10 Center Drive MSC 1666, Bethesda, MD 20892, USA

²College of Medicine, University of Illinois at Urbana-Champaign, 190 Medical Sciences Building, 506 South Mathews Ave, Urbana, IL 61801, USA

author email corresponding author email^Deceased

Lipids in Health and Disease 2008, 7:7doi:10.1186/1476-511X-7-7


Published:	10 March 2008

Abstract

Background

A relationship between corneal arcus and atherosclerosis has long been suspected but is controversial. The homozygous familial hypercholesterolemia patients in this study present a unique opportunity to assess this issue. They have both advanced atherosclerosis and corneal arcus.

Methods

This is a cross-sectional study of 17 patients homozygous for familial hypercholesterolemia presenting to the Clinical Center of the National Institutes of Health. Plasma lipoproteins, circumferential extent of arcus, thoracic aorta and coronary calcific atherosclerosis score, and Achilles tendon width were measured at the National Institutes of Health.

Results

Patients with corneal arcus had higher scores for calcific atherosclerosis (mean 2865 compared to 412), cholesterol-year score (mean 11830 mg-yr/dl compared to 5707 mg-yr/dl), and Achilles tendon width (mean 2.54 cm compared to 1.41 cm) than those without. Corneal arcus and Achilles tendon width were strongly correlated and predictive of each other. Although corneal arcus was correlated with calcific atherosclerosis (r = 0.67; p = 0.004), it was not as highly correlated as was the Achilles tendon width (r = 0.855; p < 0.001).

Conclusion

Corneal arcus reflects widespread tissue lipid deposition and is correlated with both calcific atherosclerosis and xanthomatosis in these patients. Patients with more severe arcus tend to have more severe calcific atherosclerosis. Corneal arcus is not as good an indicator of calcific atherosclerosis as Achilles tendon thickness, but its presence suggests increased atherosclerosis in these hypercholesterolemic patients.