The Relation of Corneal Arcus With Cardiovascular Diseases: A Systematic Review

The prognostic value of corneal arcus (arcus senilis) for cardiovascular disease (CVD) remains debated. We evaluated associations of arcus with cardiometabolic risk, prevalent CVD, and incident events, and summarized how consistently studies adjusted for standard risk factors. We systematically reviewed observational studies (1960-2017) from Asia, Europe, and North America. Designs included cross-sectional, case-control, and prospective cohorts. Risk of bias was appraised using the Newcastle-Ottawa Scale (cohort/case-control) and the Joanna Briggs Institute checklist (cross-sectional). Twelve studies met the inclusion criteria. The prevalence of arcus increased with age and was higher in men. Cross-sectional and case-control evidence showed consistent associations with atherogenic lipid profiles and a higher burden of prevalent CVD. Prospective findings were mixed: arcus predicted incident events in targeted subgroups (notably younger men and some Asian male populations) but offered limited independent prognostic value and minimal incremental discrimination in general, older populations once age, sex, and lipids were considered. Overall risk of bias was low in most cohorts; moderate ratings reflected limited confounder control, non-slit-lamp exposure assessment, or sampling constraints. Corneal arcus appears to primarily reflect cumulative lipid exposure. In adults under 50 years or select higher-risk men, its presence should prompt lipid evaluation and risk review; however, its low sensitivity means the absence of arcus does not exclude CVD.