A few weeks back the British Medical Journal published the results of a major Danish study looking at the significance of xanthelasmata (singular 'xanthelasma'), the flat yellow plaques occasionaly found around the eye lids of patients. The researchers surveyed 12.745 people who had participated in the Copenhagen City Heart Study. The participants were aged between 20 and 93 years and were free of heart disease when the study began. The study participants had tracked since 1976 until May 2009. At the beginning of the study 563 (4.4%) participants had xanthelasma and 3.159 (24.8%) had arcus. During follow-up, 1.872 participants suffered a heart attack, 3.699 developed heart disease, 1498 a stroke, 1815 a cerebrovascular disease and 8,507 died. The results show that in all age groups, and both for men as for women, the risk of suffering a heart attack, to develop a heart disease or die within ten years increased in individuals with xanthelasma. This increased risk is independent of other risk factors as sex, smoking, obesity or high blood pressure and cholesterol levels. The highest risks were found in men between the ages of 70 and 79 years. This study gives clear evidence to back up what I guess most practitioners are already aware of and none of us should have any hesitation in ensuring anyone presenting with xanthelasma has a blood lipid test. However, in my view the big news from this study was related to another lesion. The researchers found NO sigificant association between cardiovascular disease and arcus. I repeat, NO association. This did surprise ma and I immediately thought about the many times I have referred people in their middle age for a cholesterol check because of them having arcus. While it is a good idea for everyone over 40, especially men, to have regular check ups, the assumption that arcus in a 40 year old is related to high cholesterol levels is now in question.