Purpose To evaluate the association between xanthelasma palpebrarum (XP) and atherosclerosis by the measurement of carotid intima media thickness (CIMT). In addition, the concurrent association between metabolic syndrome, dyslipidaemia and dyslipoproteinaemia was also assessed.

Study design A cross-sectional study was conducted from January 2008 to April 2009 involving 40 patients of XP and an equal number of age, sex and body mass index matched controls. All study subjects underwent CIMT estimation by ultrasonography and were evaluated for metabolic syndrome (obesity, blood pressure, blood glucose, serum lipid profile), non-alcoholic fatty liver disease, apolipoprotein A1 and apolipoprotein B.

Results The mean CIMT was significantly higher in XP patients as compared with controls. However, there was no correlation with the extent or the duration of the XP lesions. Prevalence of metabolic syndrome was similar in both groups while non-alcoholic fatty liver disease was more frequent in XP patients as compared with controls (p=0.001). The mean serum cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglyceride levels were similar in the two groups. However, there was significant increase in the mean pro-atherogenic apolipoprotein B and decrease in the anti-atherogenic apolipoprotein A1 levels in XP patients.

Conclusions Alteration in apolipoprotein levels (A1 and B) in XP patients may predispose to cutaneous and systemic deposition of lipids, including atherosclerosis. Therefore, XP patients irrespective of their lesion size or serum lipid levels should be screened using CIMT for detection of subclinical atherosclerosis.