Association Between Xanthelasma Palpebrarum and Ankle-Brachial Index*

INTRODUCTION: Xanthelasma palpebrarum (XP) has been increasingly recognized as a potential cutaneous marker of systemic metabolic and vascular disorders. The ankle–brachial index (ABI) is a simple, non-invasive tool for detecting subclinical atherosclerotic burden. This study aimed to investigate the association between xanthelasma and ABI.
METHODS: In this single-center, descriptive cross-sectional study, 121 participants were evaluated. Patients with clinically diagnosed xanthelasma formed the study group, while age- and sex-matched individuals without xanthelasma served as controls. Demographics, cardiovascular risk factors, body mass index (BMI), and laboratory parameters were recorded. ABI was measured using a handheld Doppler device, with values ≤0.90 indicating peripheral artery disease and ≥1.30 suggesting medial arterial calcification.
RESULTS: Patients with xanthelasma had significantly higher BMI (31.8±6.4 vs. 28.7±4.1 kg/m²; p=0.002), low-density lipoprotein (LDL) cholesterol (144.7±50.2 vs. 129.2±37.1 mg/dL; p=0.046), Homeostasis Model Assessment of İnsulin Resistance (4.54±5.22 vs. 2.90±2.66; p=0.025), and free thyroxine levels (p=0.001), whereas serum 25-hydroxy Vitamin D was lower (p=0.014). ABI values were higher in the xanthelasma group (1.41±0.21 vs. 1.28±0.18; p<0.001). The prevalence of ABI ≥1.30 was significantly greater (65.6% vs. 45.0%; p=0.023). Logistic regression revealed that xanthelasma increased the risk of medial arterial calcification by 2.3-fold (odds ratio: 2.33; 95% confidence interval: 1.12–4.85).
DISCUSSION AND CONCLUSION: XP is associated with obesity, insulin resistance, elevated LDL cholesterol, and increased prevalence of ABI ≥1.30, consistent with medial arterial calcification. These findings suggest that xanthelasma may serve as a non-invasive cutaneous marker of metabolic derangements and subclinical atherosclerotic burden. ABI measurement could represent a valuable adjunct in the evaluation of patients with xanthelasma. Larger multicenter prospective studies are required to validate these associations.

Keywords: Ankle-brachial index, atherosclerosis, medial arterial calcification, peripheral arterial disease, xanthelasma palpebrarum.