Alcohol consumption, smoking and development of visible age-related signs: a prospective cohort study.

BACKGROUND: Visible age-related signs indicate biological age, as individuals that appear old for their age are more likely to be at poor health, compared with people that appear their actual age. The aim of this study was to investigate whether alcohol and smoking are associated with four visible age-related signs (arcus corneae, xanthelasmata, earlobe crease and male pattern baldness). METHODS: We used information from 11 613 individuals in the Copenhagen City Heart Study (1976-2003). Alcohol intake, smoking habits and other lifestyle factors were assessed prospectively and visible age-related signs were inspected during subsequent examinations. RESULTS: The risk of developing arcus corneae, earlobe crease and xanthelasmata increased stepwise with increased smoking as measured by pack-years. For alcohol consumption, a high intake was associated with the risk of developing arcus corneae and earlobe crease, but not xanthelasmata. CONCLUSIONS: High alcohol consumption and smoking predict development of visible age-related signs. This is the first prospective study to show that heavy alcohol use and smoking are associated with generally looking older than one's actual age.

Estudio descriptivo sobre el carcinoma basocelular en el párpado / Descriptive study on basal cell eyelid carcinoma

OBJETIVO: Describir la presentación y características del carcinoma basocelular en los párpados. MATERIAL Y MÉTODOS: Se realiza un estudio retrospectivo a través de la revisión de historias clínicas, resultados anatomopatológicos y fotografías de 200 pacientes consecutivos con carcinoma basocelular palpebral intervenidos en la clínica oftalmológica Herzog Carl Theodor de Múnich, Alemania, entre los años 2000 y 2013. RESULTADOS: En el presente estudio las mujeres se afectan de forma más frecuente. La edad media son los 70 años. La afectación del párpado inferior se presenta en la mitad de los casos, siendo especialmente frecuente en el tercio central. El 47% de los carcinomas estudiados afectan al margen palpebral. El diámetro promedio es de 9,2 mm. El porcentaje de recidivas tras cirugía con márgenes limpios es del 5%. Estadísticamente se encuentran correlaciones significativas, de tal forma que, a mayor diámetro de la lesión mayor edad del paciente; los tumores aparecen con mayores tamaños a medida que se alejan de la zona medial y se acercan al margen del párpado. CONCLUSIONES: Existe un predominio de afectación en el sexo femenino; esto puede deberse a que la toma de la muestra pertenece a una consulta de cirugía oculoplástica. La aparición del carcinoma aumenta conforme avanza la edad. Existe una menor incidencia de basaliomas en el párpado superior que puede estar relacionada con la protección de la ceja frente a la luz solar. La mayor afectación del párpado inferior puede estar relacionada con un efecto de reflexión de la luz por la córnea hacia dicho párpado. Otra teoría se basa en el daño químico y físico producido por la concentración lagrimal. Los pacientes acuden a consulta de forma más precoz en edades más tempranas, si son mujeres, si se trata de tumores más cercanos a la zona medial y cuando hay mayor lejanía del margen palpebral

OBJECTIVE: To describe a series of cases of basal cell carcinomas of the eyelid. METHODS: A descriptive and retrospective study was conducted by reviewing the medical outcome, histopathological history, and photographic images of 200 patients with basal cell eyelid carcinomas. All were treated in the Herzog Carl Theodor Eye Hospital in Munich, Germany, between 2000 and 2013. RESULTS: In the present study, it was found that females are more affected than males. The mean age of presentation of the tumor occurred at the age of 70 years. In 50% of the cases the tumor was found on the lower lid, especially medially from the center of the lid. The lid margin was involved in 47% of all tumors. The mean diameter was 9.2 mm. The recurrence rate after surgery with histologically clear resection margins was 5%. There was a significant relationship between tumor diameter and age. As tumors where located farther away from medial and closer to the lid margin, they became larger. CONCLUSIONS: There is a predominance of women affected by this tumor. This may be related to the fact that the sample was taken from those attending an oculoplastic surgery clinic, where there are generally more women than men attending. The formation of basal cell carcinomas increases with age. The infrequent involvement of the upper lid could be explained by the protection of the the eyebrow. The frequent involvement of the lower lid may be due to the light reflection (total reflection) by the cornea on the lower lid margin. Also chemical and physical effects of the tears may be more harmful on the lower lid. Patients tend to ask for medical help when they are females, younger, when the tumor is closer to the medial canthus or when the tumor is away from the lid margin

Acute myocardial infarction in a 28 year man with familial hypercholesterolemia.

Familial hypercholesterolemia is a single gene disorder. It has autosomal dominant pattern of inheritance. We report a 28-year-old man who presented with acute myocardial infarction. He had xanthomas and an elevated serum low density lipoprotein cholesterol (LDL-C). His only sibling, 32-year-old brother have similar cutaneous lesions and lipid profile. His mother and maternal uncle died at a young age due to myocardial infarction. This report is to emphasize the need to clinically recognize xanthomas and its familial inheritance with elevated LDL-C, premature atherosclerosis. Early diagnosis and early initiation of treatment will save the affected individual and the other family members.

Xanthelasmata, arcus corneae, and ischaemic vascular disease and death in general population: prospective cohort study.

OBJECTIVE: To test the hypothesis that xanthelasmata and arcus corneae, individually and combined, predict risk of ischaemic vascular disease and death in the general population. DESIGN: Prospective population based cohort study. SETTING: The Copenhagen City Heart Study. PARTICIPANTS: 12,745 people aged 20-93 years free of ischaemic vascular disease at baseline and followed from 1976-8 until May 2009 with 100% complete follow-up. MAIN OUTCOME MEASURES: Hazard ratios for myocardial infarction, ischaemic heart disease, ischaemic stroke, ischaemic cerebrovascular disease, and death; odds ratios for severe atherosclerosis. RESULTS: 563 (4.4%) of participants had xanthelasmata and 3159 (24.8%) had arcus corneae at baseline. During 33 years' follow-up (mean 22 years), 1872 developed myocardial infarction, 3699 developed ischaemic heart disease, 1498 developed ischaemic stroke, 1815 developed ischaemic cerebrovascular disease, and 8507 died. Multifactorially adjusted hazard/odds ratios for people with versus those without xanthelasmata were 1.48 (95% confidence interval 1.23 to 1.79) for myocardial infarction, 1.39 (1.20 to 1.60) for ischaemic heart disease, 0.94 (0.73 to 1.21) for ischaemic stroke, 0.91 (0.72 to 1.15) for ischaemic cerebrovascular disease, 1.69 (1.03 to 2.79) for severe atherosclerosis, and 1.14 (1.04 to 1.26) for death. The corresponding hazard/odds ratios for people with versus those without arcus corneae were non-significant. In people with versus those without both xanthelasmata and arcus corneae, hazard/odds ratios were 1.47 (1.09 to 1.99) for myocardial infarction, 1.56 (1.25 to 1.94) for ischaemic heart disease, 0.87 (0.57 to 1.31) for ischaemic stroke, 0.86 (0.58 to 1.26) for ischaemic cerebrovascular disease, 2.75 (0.75 to 10.1) for severe atherosclerosis, and 1.09 (0.93 to 1.28) for death. In all age groups in both women and men, absolute 10 year risk of myocardial infarction, ischaemic heart disease, and death increased in the presence of xanthelasmata. The highest absolute 10 year risks of ischaemic heart disease of 53% and 41% were found in men aged 70-79 years with and without xanthelasmata. Corresponding values in women were 35% and 27%. CONCLUSION: Xanthelasmata predict risk of myocardial infarction, ischaemic heart disease, severe atherosclerosis, and death in the general population, independently of well known cardiovascular risk factors, including plasma cholesterol and triglyceride concentrations. In contrast, arcus corneae is not an important independent predictor of risk.

Corneal arcus: an indicator of severe coronary artery disease in a young adult man.

A 32-year-old man was transferred to our emergency service with the diagnosis of sudden cardiopulmonary arrest. During eye examination, a typical corneal arcus was observed. The patient underwent the primary percutaneous coronary intervention. Coronary angiography showed a total occlusion of proximal left anterior descending artery. Primary coronary balloon angioplasty was successfully performed. Independently of total cholesterol, serum high-density lipoprotein cholesterol and smoking, corneal arcus has been suggested as a predictor of coronary heart disease among hyperlipidemic men. Physical examination can yield valuable diagnostic clues in a patient suspected of ischaemic heart disease. In summary, the appearance of corneal arcus in young adult men might be an indicator of severe coronary artery disease and should be screened by means of physical examination especially in the setting of cardiopulmonary arrest (Fig. 1, Ref. 4).

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). CONCLUSION: 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.

[Unilateral ptosis in the background of unilateral corneal arcus lipoides -- a case report]. / Unilaterale Ptosis assoziiert mit unilateralem Arcus lipoides -- Kasuistik.

BACKGROUND: Arcus lipoides corneae is a common bilateral degenerative disorder with ageing but only rarely occurs unilaterally. Clinically visible cream-coloured ring-shaped corneal opacities are caused by excessive lipoid deposits in the corneal stroma. Our aim is to discuss theoretical aspects of the possible impact and pathomechanism of unilateral ptosis in unilateral arcus lipoides. CASE REPORT: The authors report the case of a 70-year-old female patient who was treated for chronic pancreatitis and hyperlipoproteinemia. She had congenital ptosis on the left side, and an arcus lipoides corneae in her left eye. The patient underwent extracapsular cataract extraction, and irregular high-grade astigmatism developed. An irregularity of the wound healing was apparent from the keratometric values, which decreased after removal of the corneal sutures. CONCLUSION: The known etiological factors of unilateral arcus lipoides, like contralateral stenosis of the internal carotid artery, traumatic or iatrogenic hypotony, chronic iridocyclitis of the eye were absent in our patient.

Latent model for correlated binary data with diagnostic error.

We propose a methodology for modeling correlated binary data measured with diagnostic error. A shared random effect is used to induce correlations in repeated true latent binary outcomes and in observed responses and to link the probability of a true positive outcome with the probability of having a diagnosis error. We evaluate the performance of our proposed approach through simulations and compare it with an ad hoc approach. The methodology is illustrated with data from a study that assessed the probability of corneal arcus in patients with familial hypercholesterolemia.

[Corneal arcus and life expectancy]. / Arcus corneae és élettartam.

In 1964-66, the authors completed the comprehensive medical screening of 1412 persons. Apart from the indicators of health state they also recorded their social and cultural parameters. The diagnoses they registered included AC, which has been covered in literature in rather contradicting ways. They found no data concerning survival; as analysing such a correlation is only possible within the frame-work of a several-decade follow-up study. By the end of the follow-up stage (31:12:1994), after 30 years, 1375 persons had died. Their death certificates and--if there were any--necropsy records have been processed and thoroughly analysed. They examined the occurrence of AC, life duration and survival probability--all in correlation with age, gender, constitution, certain diseases (hypertonia, ostheoarthrosis) and diagnoses at death (ischaemic heart diseases, acute myocardiac infarction, cerebrovascular diseases). They point it out that the occurrence of AC is significantly higher among males, but it increases in strong correlation with age in both sexes. Those who had AC were found to be older at the time of death, but it doesn't mean that AC correlates with better life expectancy--it means that AC occurs at older age. The survival probability of men over 75 was better than that of women. On the whole, AC is unfavourable concerning life expectancy, but the later it occurs, the less it can be used as an indicator of life expectancy. It was found that greater average weight correlated with longer average life duration, while among females the more a person weighed, the less frequent AC became. It was true for each weight group that those with AC had worse life expectancy. Altogether those with no AC were found to suffer from hypertonia significantly more frequently. The life expectancy of those with both AC and hypertonia, however, was always worse than those with hypertonia only, regardless of age and the type of hypertonia. Generally women are in a more favourable position, but in the 'serious' and 'very serious' hypertonia groups there is practically no difference in the survival of the two sexes. The authors have also found that AC has a significant negative prognostical value concerning survival and correlation with ostheoarthrosis, ischaemic heart diseases and cerebrovascular diseases. The correlation of AC with acute myocardiac infarction could not be proved convincingly.

Corneal arcus, case finding and definition of individual clinical risk in heterozygous familial hypercholesterolaemia.

Premature corneal arcus may identify individuals with hyperlipidaemia and increased cardiovascular risk. We have attempted to quantitate relationships through determination of graded prevalence of corneal arcus with age for 81 males and 73 females suffering from heterozygous familial hypercholesterolaemia (HFH) at presentation, and for 280 male and 353 female unselected patients (age range 16-76 years) attending a country general practice. Some degree of arcus affected 50% of HFH patients by age 31-35 years, and 50% of practice patients by age 41-45 years. Complete full ring arcus affected 50% of the familial hypercholesterolaemia (FH) group by age 50 years, with only 5% similarly affected in the non-FH group. Arcus grade with age was advanced by some 5 years in males versus females. Premature arcus potentially alerting to HFH can be broadly defined for males and females combined, as heavy full ring by age 50 years, or any degree of arcus by age 30-35 years. Arcus grade was not related to the presence of coronary disease. Accelerated development of corneal arcus with age is an indicator of HFH, but premature arcus is not an additional marker of premature coronary disease for individual cases of HFH.

Epithelial iron line in juvenile corneal arcus lipoides.

Iron lines of the corneal epithelium are well-described phenomena in both normal and pathologic conditions. We found a bilateral corneal epithelial iron line at the inner edge of a juvenile corneal arcus lipoides in an otherwise normal eye of a 38-year-old white man. Possible mechanisms that may have led to the development of this new iron line are discussed.

[Fish eye disease]. / Fischaugenkrankheit.

A 67-year-old man complained of impaired vision at night for several months. He was known to have arcus senilis (arcus lipoides corneae) since aged 21 years. For the last 20 years both corneas had become progressively more cloudy. His mother was said to have had similar eye changes. Ophthalmological examination discovered no abnormality other than marked corneal dystrophy with hardly separable arcus senilis. General physical examination was normal. Total cholesterol and triglyceride levels in serum were within normal limits, but serum concentration of high density lipoprotein (HDL) cholesterol (8 mg/dl) was reduced as were, within the high density lipoprotein fraction, the concentrations of triglyceride (4 mg/dl), phospholipids (38 mg/dl), the proportion of cholesterol esters (31%), and the cholesterol-esterification rate (51 nmol/ml . h). The HDL-associated activity of lecithin-cholesterol-acetyltransferase activity was scarcely measurable (0.9 nmol/ml . h). The signs in this case (cloudy cornea, marked decrease in serum HDL cholesterol concentration without premature arteriosclerosis) are typical of fish eye disease.

Gerontoxon precoce / Early gerontoxon

Doze casos de gerontoxon precoce säo estudados. É discutida a relaçäo entre os níveis de colesterolemia e lipiolemia no surgimento desta patologia

The association of corneal arcus with coronary heart disease and cardiovascular disease mortality in the Lipid Research Clinics Mortality Follow-up Study.

The relationship between corneal arcus (arcus senilis) and mortality from coronary heart disease (CHD) and cardiovascular disease (CVD) is examined in a prospective study of White men (n = 3,930) and women non-hormone users (n = 2,139), ages 30-69, followed for an average of 8.4 years as part of the Lipid Research Clinics Mortality Follow-up Study. After excluding those with clinically manifest CHD at baseline, corneal arcus was strongly associated with CHD and CVD mortality only in hyperlipidemic men ages 30-49 years, for whom the relative risk for CHD and CVD death was 3.7 and 4.0, respectively, after adjusting for age, total cholesterol, HDL cholesterol, and smoking status using a Cox proportional hazards model. Among 30-49 year old males, corneal arcus appears to be a prognostic factor for CHD, independent of its association with hyperlipidemia in this age-group, of about the same magnitude as other common risk factors, underscoring the usefulness of corneal arcus as a prognostic factor to the practicing clinician.