Xanthoma

[runnertom]

Thank you for entertaining my question.
I have posted before. I am 55 yo long 30 year very heavy exerciser who thought his heart disease risk was negligable. Never smoked, normal bp, TC~220. Father died age 79 of cancer and had bypass in mid 60's after 40 years of smoking. His 5 brothers and sisters alive ages 80 to 91 (one bypass). Mother and her sisters all doing well at 70 to 82. I, being the lucky one I guess found out last Feb that I had 90% occlusion of LAD and 1st diagonal that was subsequently bypassed. I have been on a quest since then to identify the cause for what I perceived to be premature CAD. My lipids are now under good control with LDL of 80 and HDL of 61 via Pravachol. However, a new cardio recently found that I have some aortic regurgitation and mild carotid stenosis.

I have recently become aware of a condition of xanthoma which I am nearly certain I have. It is in the form of small yellow bumps under the surface of the skin of my upper lip. They have been there for at least 25 to 30 years, and I am not aware of them progressing. My father had some bumpy outcroppings around his eyes that the doctor told him were cholesterol. One of my sisters (an RN) also has something she says is similar. I know that xanthoma is a genetically aquired condition that is normally a symptom of hyperlipidemia, but am having trouble finding what to do about it. Assuming I am confirmed to have xanthoma, is there anything I can do other than exercise good lipid control? I am thinking my lipids may have been very much worse back in my 20's before I became a heavy exerciser.

[CCF-M.D.-RCJ]

Runnertom,

Thanks for the post.

Firstly, appearance of xanthoma in the 20's would be unusual outside of a familial hyperlipidemic syndrome or other metabolic derangement.

Q:"Assuming I am confirmed to have xanthoma, is there anything I can do other than exercise good lipid control?"

Not to my knowledge.  A dermatologist might be able to prescribe therapy if you find the "small yellow bumps" disconcerting.

In response to your follow-up, we just don't have good information about how a particular diet might affect xanthoma.  My suspicion (and I could be wrong) is that whichever diet maximally decreases your LDL and triglycerides would have the most pronounced effect on the xanthoma, if that is indeed what you have.

Best of luck.

[runnertom]

I forgot to add that contrary to expectations for xanthoma, my fasting triglycerides are also quite low at about 55. The only dietary info I have found is if I have this inherited disorder, a low fat high carb diet is exactly the wrong therapy. Sugars make the intemediate density lipoproteins shoot up. Does that mean Adkins diet would be appropriate?

[knicks30]

You should check for high levels of C-reactive Protein, high levels of Homocystine, how was your cholestorol when you were diagnosed with CAD? You do have a family history but considering you got earlier than your other family members so i suggest look into the other causes like i listed above.

Good luck,

[runnertom]

My most recent cholesterol test prior to surgery was 220 total. After surgery, I discovered high homocysteine of about 17 after I had already been taking folic acid. CRP is OK. Everything considered, this xanthoma and possible familial hypercholesterimia is the closest I have come to finding the "smoking gun". From what I have read, the homocsysteine does indeed increase risk of CAD, but nothing compared to what is implied by the xanthoma. One statement I read was that 50% to 60% of sufferers die from heart attacks by age 60! On the other hand, Robert Superko in his book "Before the Heart Attacks" states that the Apo 2/2 problem is a perfect example of a genetic condition that can be controlled completely. Beyond warning that sugars are the worst thing for these people, he really offers no help. I think it is quite feasible that I had the lipids under control in recent years and the underlying damage leading to my problems was done long ago. I was really suffering none of the classic symptoms of ischemia other than transient shortness of breath in the first 1/4 mile of running.

[knicks30]

you say your cholestorol was 220 in total. What was your HDL and LDL? I have never heard of Xanthoma, i should look up more info on that. If xanthoma can be treated and you still go on your ways of exercising like you do youll probably be fine by you reach 60.

good luck.

[knicks30]

Sorry i just realized that you did state your LDL and HDL. 80 and 61 but with medication how was it before you took medication to control the lipids and how were your triglycerides?

[runningguy]

Hi Runnertom! Our histories are very similar. I thought I was the only person around in my situation. I am a 52 year old guy who has been running 30 to 50 miles per week for the last 25 years. I have always been in the 155 to 170 lb weight range and I am about 6' tall. I did smoke for about 10 years (quit at 27) but other than that, I have had a very clean lifestyle. My parents are both still alive at 80 and neither of them have any known heart disease. My cholesterol has always been below 200.  My HDL was typically 65+.

Three years ago, I decided to have a calcium (EBT?) scan after one of my running buddies died for a MI. To my suprise, I scored a 113 which was at the 89th percentile. I went on zocor 5mg and watched my fats.  I rechecked at 2 1/2 years a scored a 177. Yikes, I was freaked out! I am now on a super lowfat/high carb diet and my TC cholesterol is about 140.

My lesions are right in the same area as yours. I have added Vit C and E along with B Vitamins to my diet. I have not taken them in the past. Thanks for the tip on Xanthoma. I want to look into this. My doctor just shrugs his shoulders when he talks about my situation. He just doesn't know what to say. Did you take vitamins over your years of running? I am wondering if my lack of vitamin supplementation might have caused LDL oxidation in my bloodstream during exercise?

[runningguy]

Hi Pluto. Thanks for bringing up an interesting point. My doctor did warn me to not take more than 400 IU of vitamin E per day. I bought myself a Cardiocheck to assay my lipid levels and found that 800 IU of vitamin E per day did seem to lower my HDL levels about 20%. I feel that some vitamin E is necessary because of my heavy exercise habit and am holding at 400 IU per day. I check my HDL and LDL one to two times per month and find my HDL comes down with my LDL. When my total cholesterol is at 140 or less, it is hard to maintain a HDL over 55. When my total cholesterol was in the 180 range, my HDL was in a range of 65 to 72. I am glad that I found this board, it makes life more comfortable when you can learn from the experience of others. I have learned a lot reading posts here. Good to meet you Pluto!