Correlating corneal arcus with atherosclerosis in familial hypercholesterolemia.
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).


CONCLUSIONS
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.
Zech
Loren A
LA
Molecular 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. lzech@uiuc.edu
Hoeg
Jeffery M
JM
D000125:Achilles Tendon / Q000473:pathology; D000293:Adolescent; D000328:Adult; D001112:Arcus Senilis / Q000150:complications*; D050197:Atherosclerosis / Q000150:complications*; D002114:Calcinosis / Q000150:complications; D009202:Cardiomyopathies / Q000150:complications; D002648:Child; D002675:Child, Preschool; D005260:Female; D006720:Homozygote; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications* / Q000235:genetics*; D007223:Infant; D008074:Lipoproteins / Q000097:blood; D008297:Male
D008074:Lipoproteins