Skin telangiectases in primary aluminium production workers were first described in 1976 among Polish workers.1 The lesions displayed unique clinical fea tures. They were round non-pruritic red macules whitening on pressure, with sharp edges and ranging in size from 1 to 30 mm. The upper part of the body was chiefly affected: chest, back, shoulders, forearms, neck, and face in order of frequency. Microscopically, they resulted from elastoid d?g?n?rescence of con nective tissue surrounding the arteriolar, venular, and capillary portion of the p?riph?rie vessels, accom panied by a mononuclear infiltrate. The capillaries were distended and oedematous. A Russian study showed that the attack rate was significantly higher in electrolysis workers.2 In a later study carried out in Quebec the group at risk was narrowed down to workers in the Soderberg electrol ysis process, which releases more complex aromatic hydrocarbons in the environment than the newer pro cess (prebake).3 After four years of seniority in the Soderberg process, 40% of the workers had more than 10 skin lesions and after 20 years nearly all were affected. Skin telangiectases were found to be associated with an excess of ECG abnormalities.4 No other asso ciation with life style habits or other disease could be identified. The present study, conducted in a large aluminium reduction plant in Quebec, Canada, employing over 6000 men, is an attempt to confirm the association between skin telangiectases and ischaemic heart disease. Stroke and arterial insufficiency of the lower extremities (AILE) were also included as ischaemic outcomes.