If This Happens To Your Toe, You Might Have A Serious Cholesterol Problem

What can our toes tell us about our cardiovascular health? Quite a bit, actually. People with hypertension (high blood pressure), hypercholesterolemia (high cholesterol), or individuals who smoke are susceptible to what's known as cholesterol emboli, explains the Cleveland Clinic. Cholesterol emboli are small cholesterol crystals that have broken off from plaque lining the artery walls. If these crystals become wedged in smaller arteries, the obstruction of blood flow may cause harm to our essential organs.

Known incidence rates of cholesterol emboli stand at less than 3.5%, according to updated 2024 information published in StatPearls. Although rare, the majority of cases develop in relation to intra-arterial surgery, with fewer than 5% of cases occurring spontaneously. Cholesterol emboli are more often seen in older adults with atherosclerotic heart disease, which has been linked with high cholesterol as a risk factor. So what does this all have to do with our feet? The presence of cholesterol emboli is sometimes alternatively referred to as "blue toe syndrome." Here's why.

What is blue toe syndrome?

Blue toe syndrome refers to the bluing of one or more toes that occurs due to reduced circulation from arterial obstruction, according to a 2023 research article published in BMJ Case Reports. This discoloration is often accompanied by pain or tenderness, and cholesterol emboli are most often the cause. Such was the case for a man in his 90s who experienced pain, swelling, and purpling of his toes. The patient had been taking three different medications, including warfarin, for the treatment of various cardiovascular diseases. Cholesterol emboli were determined to be the cause of the patient's blue toe syndrome, which began to clear up after the man's medication had been adjusted.

Similarly, in a 2023 study published in Cureus, a male in his 70s with numerous health conditions was found to have developed blue toe syndrome related to cholesterol embolization syndrome (CES) — in which multiple cholesterol particles break off — in the aftermath of coronary artery bypass surgery. The patient's symptoms included his toes turning purple along with burning sensations. Among other health conditions, the patient had a history of hyperlipidemia, which is characterized by high levels of total cholesterol, LDL "bad" cholesterol, and triglycerides or low levels of HDL "good" cholesterol (per StatPearls). Taking steps to regulate lipid levels in the body, however, can lower the risk of atherosclerotic cardiovascular disease and potentially related cholesterol emboli.

Prevention strategies to minimize risk of cholesterol emboli

Not all cases of cholesterol emboli are the same, so treatment options may vary. Cases related to atherosclerosis, for example, are often treated with antiplatelet and statin medications (per StatPearls). When taken to lower cholesterol levels, statins can come with side effects. Without treatment, however, cholesterol emboli can increase the risk of pancreatitis, renal insufficiency, myocardial ischemia, multi-organ failure, and more, depending on which organs are impacted.

Cholesterol embolization syndrome can also be life-threatening, with one-year survival rates standing at 87% and four-year survival rates falling to 52%. However, implementing atherosclerosis prevention strategies can help reduce the risk of blue toe syndrome. This includes not smoking, managing blood pressure levels, maintaining a healthy weight, and eating a healthy diet. Patients will also want to take any medications as prescribed and keep up with regular doctor appointments. Seek urgent medical attention if you experience a stroke or a transient ischemic attack (TIA) — characterized by stroke symptoms that last only minutes or resolve within 24 hours (per Cleveland Clinic).