Elsevier

Atherosclerosis

Volume 193, Issue 2, August 2007, Pages 235-240
Atherosclerosis

Review
Corneal arcus as coronary artery disease risk factor

https://doi.org/10.1016/j.atherosclerosis.2006.08.060Get rights and content

Abstract

Corneal arcus is a lipid-rich and predominantly extracellular deposit that forms at the corneoscleral limbus. It represents the most common peripheral corneal opacity and is not associated with tissue breakdown but rather with the deposition of lipids. The deposition of cholesterol in the peripheral cornea and arterial wall are similar in that both are accelerated by elevated serum levels of atherogenic lipoproteins, such as low-density lipoproteins (LDL). Corneal arcus is more prevalent in men than in women and in Blacks than in Whites. Its prevalence increases with advancing age. It has been associated with hypercholesterolemia, xanthelasmas, alcohol, blood pressure, cigarette smoking, diabetes, age, and coronary heart disease. Nevertheless, it is not clear whether or not corneal arcus is an independent risk factor for coronary heart disease (CHD). The present systematic review examines the relationship of corneal arcus and CHD to determine if corneal arcus is an independent CHD risk factor. We conclude that there is no consensus that corneal arcus is an independent risk factor. The presence of corneal arcus in a young person should prompt a search for lipid abnormalities. Also, because corneal arcus represents physical evidence of early lipid deposition, its presence suggests the need for aggressive lipid therapy.

Introduction

Estimates of individual atherosclerotic cardiovascular disease (ASCVD) risk are based on historical or physical examination findings of atherosclerosis as well as measurements of atherosclerotic risk factors, such as serum lipids, blood pressure, and cigarette use [1]. Such estimates are not exact and have prompted the use of nontraditional risk factors, such as lipoprotein particle size, high sensitivity C-reactive protein [2], lipoprotein a, and coronary artery calcification scoring [3] to assess ASCVD risk more accurately. Corneal arcus was first suggested as a cardiac risk factor by Virchow in 1852 [4], and has been supported by several subsequent studies. The present report presents a systematic review of corneal arcus as a coronary heart disease (CHD) risk factor.

Section snippets

Methods

We performed a systematic literature search of articles published in English with Pub Med through July 2005 using the search terms “corneal arcus” alone and in combination with “coronary heart disease”, “hypercholesterolemia” or “atherosclerosis”. Abstracts and the retrieved articles relevant to corneal arcus, atherosclerotic disease and hypercholesterolemia were reviewed in detail. Older references from these articles were also reviewed. Studies based on small number of patients were not

Summary

Corneal arcus is a recognized sign of hyperlipidemia. It has been associated with CHD since Virchow's initial observation in 1852, but despite the length of this association, it is still not clear whether corneal arcus’ association with CHD is statistically independent of other risk factors, primarily hyperlipidemia. We suggest that physicians use the presence of corneal arcus to search for hyperlipidemia. In addition, given the association of arcus and CHD, normolipidemic patients with corneal

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