Author + information
- Ali Rıza Akyüz1,
- Mustafa Tarık Ağaç2,
- Turhan Turan1,
- Sinan Şahin4,
- Selim Kul3,
- Levent Korkmaz2,
- Musluhittin Emre Erkuş5,
- Hakan Erkan2 and
- Şükrü Çelik2
Appraisal of certain cutaneous markers linked to coronary artery disease may help clinician to suspect disease in the subclinical phase. Xanthelasma palpebrum is a common cutaneous sign which was shown to predict the risk of ischemic heart disease in general population, independently of well known cardiovascular risk factors. Increased amount of epicardial adipose tissue, which is considered as visceral fat of heart, was shown to promote coronary atherosclerosis through local paracrine effects, in addition to associated systemic inflammation.
In the present study, we aimed to compare the amount of epicardial adipose tissue in subjects with and without xanthelasma.
Consecutive 52 patients with xanthelasma and age- gender matched 48 control subjects were enrolled. Epicardial adipose tissue was assessed by measuring epicardial fat thickness (EFT) by echocardiography. Data were collected concerning coronary artery disease risk factors by clinical history, and blood chemistry.
Subjects with xanthelasma had higher body mass index (BMI) (31.3±5.8 vs. 28.0±5.9, p=0.008), and higher levels of total cholesterol (218±55 mg/dl vs. 172 ± 34 mg/dl, p<0.001), LDL-c (144±46 mg/dl vs. 111±32 mg/dl, p<0.001), and triglyceride (median 154 mg/dl vs. 110 mg/dl, p<0.001) compared to control subjects (Table 1). Other risk factors and HDL-c levels were similar in both groups. Median EFT was 4 mm in the study population. Epicardial fat thickness was significantly higher in subjects with xanthelasma as compared to controls (5.0±2.0 vs. 3.1±1.8, p<0.001). Binary logistic regression analysis was performed to find the independent factors associated with supramedian epicardial fat thickness (EFT>4 mm). In this model, presence of xanthelasma (OR, 27.1; 95% CI, 4.4-168.3, p<0.001) and triglyceride level (OR, 1.02; 95% CI, 1.00-1.03, p < 0.021) were found to be independently associated with supramedian EFT (Table 2).
In the present study, we found higher amount of epicardial adipose tissue in subjects with xanthelasma. In addition, presence of xanthelasma was found to be independently associated with supramedian EFT.
|Xanthelasma present (n=52)||Xanthelasma absent (n=48)||p|
|Age, years||50.8 ± 10.6||48.9 ± 17.1||NS|
|Diabetes mellitus, n(%)||9 (17.3)||2 (4.1)||NS|
|Hypertension, n(%)||22 (42.3)||14 (29.2)||NS|
|Current smokers, n(%)||1 (1.9)||4 (8.3)||NS|
|BMI (kg/m2)||31.3 ± 5.8||28.0 ± 5.9||0.008|
|Total cholesterol (mg/dl)||218 ± 55||172 ± 34||<0.001|
|HDL-c (mg/dl)||49 ± 14||52 ± 15||NS|
|LDL-c (mg/dl)||144 ± 46||111 ± 32||<0.001|
|Triglyceride (mg/dl)*||154 (107-200)||110 (71-137)||<0.001|
|Serum creatinine (mg/dl)||0.75 ± 0.17||0.72 ± 0.11||NS|
|Epicardial fat thickness|
|5.0 ± 2.0||3.1 ± 1.8||<0.001|
BMI, body mass index; HDL-c, high-density lipoprotein cholesterol; LDL-c, low-density lipoprotein cholesterol; NS, non-significant. Data are expressed as no. (%) or mean ± standard deviation. *Data are presented as median and interquartile ranges.
|Variables||EFT > 4 mm||EFT ≤4 mm||OR (95% CI)||P|
|Triglyceride, mg/dl.||170 ± 109||125 ± 60||1.02 (1.00-1.03)||0.021|
|Xanthelasma, n (%)||45 (92 %)||21 (41 %)||27.1 (4.4-168.3)||<0.001|
The covariates included sex, age, BMI, smoking status, total cholesterol, triglycerides, HDL-c, LDL-c, serum creatinine, presence of hypertension, diabetes mellitus, and xanthelasma. BMI, body mass index; EFT, epicardial fat thickness; HDL-c, high- density lipoprotein cholesterol; LDL-c, low-density lipoprotein cholesterol.