SUMMARY The relationships between coronary artery disease risk factors and corneal arcus were examined in 150 adults aged 55 years and above of both sexes and from different ethnic origins. The width of the corneal arcus was measured accurately by a digitiser, and the risk factors for coronary artery disease were examined according to the standard procedure used by the Lipid Research Clinics. The results show that the corneal arcus is more frequent in males; the frequency and size of corneal arcus are positively associated with age; there is a positive correlation between the size of corneal arcus and the levels of cholesterol and low-density lipoprotein in males; and that there is negative correlation between corneal arcus and diastolic blood pressure in both sexes. No associations were found between corneal arcus and other coronary artery disease risk factors such as triglyceride, high-density lipoprotein, very low-density lipoprotein, weight, Quetelet's ratio, glucose, and smoking.Corneal arcus is a common change of the aging cornea. Lipids accumulate at the periphery of the cornea (in the peripheral corneal stroma, Bowman's membrane, and Descemet's membrane) and form a ring-like opacity. A clear zone of about 1 mm remains between the corneal arcus and the limbus; the central part of the cornea is never involved. IThe corneal arcus is clinically harmless. Vision is not diminished, and ulcerations and vascularisation of the cornea do not occur. Corneal arcus is nevertheless interesting because of its occurrence with certain other diseases, such as hyperlipoproteinaemia, especially types II and III.2Several investigators have reported that corneal arcus is more likely to occur in patients with coronary artery disease (CAD) than in healthy controls, especially those under 50 years of age,3 while another7 noted significant correlation between the degree of corneal arcus and the incidence of electrocardiographic abnormalities in elderly patients.

Corneal arcus and coronary heart disease mortality SIR, Previous studies in western countries reported an association between corneal arcus and coronary heart disease (CHD). '2 In-hospital studies have shown that corneal arcus is a useful discriminator between CHD patients and controls.' The mechanism of the statistical association between arcus and CHD is unclear, and several studies suggest that the two are not directly related but rather that both are associated (independently) with elevated cholesterol levels.24" Evans County, Georgia, a biracial, rural community located in the high stroke region7 of the southeastern United States, has been the subject of a longitudinal study of cardiovascular disease since its inception in 1960. All county residents aged 40 and older and 50% of those less than age 40 were invited to participate in the study. 3102 (92%) agreed and were examined during 1960-2. The race and sex composition of the cohort is as follows: 947 white males, 972 white females, 537 black males, and 646 black females. Visual inspection of corneal arcus was included in the baseline physical examination and was diagnosed in 625 persons. Mortality surveillance for this cohort has been maintained. Causes of death extracted from death certificates were classified according to the eighth revised edition of the International Classification of Disease (ICD). As of mid 1980 64% of the original cohort were known to be alive, 34% deceased, and 2% were lost to follow-up. The present data included examinees aged 40 and older at baseline. Of these 2216 subjects 60 have been excluded because their arcus status was unknown, and an additional 90 are excluded because of prevalent heart disease at baseline examination. An additional 35 people are excluded because, although deceased, their death certificates were not available, and exact date of death is unknown. The age, sex, and race specific means of serum cholesterol, blood pressure (systolic and diastolic) and weight/height2x 10(X) (Quetelet index)