Some external features serve as a warning sign for accelerated atherosclerosis. Their early recognition may help in early detection and primary prevention/preemptive treatment of coronary artery disease (CAD). A 35-year-old nonsmoker, nonalcoholic, nonhypertensive, nondiabetic male presented with chest pain and was diagnosed to have acute ST elevation inferior wall myocardial infarction. His father had died of CAD at 40 years of age. The patient had bilateral extensive xanthelasma and gynoid obesity. His mother and younger brother also had evidence of bilateral xanthelasma; both turned out to be dyslipidemic - the younger brother qualifying for therapeutic intervention for dyslipidemia at 26 years of age. This case highlights the importance of familial xanthelasma as a cutaneous marker for underlying dyslipidemia and accelerated atherosclerosis in the young.
Keywords: Dyslipidemia; familial xanthelasma; premature coronary artery disease.