Association of Achilles tendon thickness with lipid profile and carotid IMT in patients with familial hypercholesterolemia

• Published in: Atherosclerosis Vol. 403; p. 119173
• Main Authors: Michikura, Masahito, Ogura, Masatsune, Hori, Mika, Matsuki, Kota, Makino, Hisashi, Fujioka, Shimpei, Shishikura, Daisuke, Hoshiga, Masaaki, Harada-Shiba, Mariko
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.04.2025
• Subjects: Achilles tendon; Achilles Tendon - diagnostic imaging; Adolescent; Adult; Biomarkers - blood; Carotid Artery Diseases - blood; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - etiology; Carotid Intima-Media Thickness; Cholesterol, LDL - blood; Cumulative low-density lipoprotein cholesterol; Familial hypercholesterolemia; Female; Humans; Hyperlipoproteinemia Type II - blood; Hyperlipoproteinemia Type II - complications; Hyperlipoproteinemia Type II - diagnosis; Hyperlipoproteinemia Type II - genetics; Lipids - blood; Male; Middle Aged; Predictive Value of Tests; Risk Factors; Ultrasonography; Untreated high-density lipoprotein cholesterol; Young Adult; Achilles tendon; Familial hypercholesterolemia; Untreated high-density lipoprotein cholesterol; Cumulative low-density lipoprotein cholesterol; Ultrasonography
• ISSN: 0021-9150; 1879-1484; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2025.119173

Familial hypercholesterolemia (FH) is characterized by high levels of low-density lipoprotein cholesterol (LDL-C) and Achilles tendon (AT) thickening. AT thickness (ATT) is useful for diagnosing FH and assessing the risk of coronary artery disease (CAD). Nevertheless, the relationship between AT thickening and lipid profile is not clear. We investigated the association of ATT with lipid Profile and carotid IMT. We included 450 patients with clinically diagnosed heterozygous FH. ATT was measured by ultrasonography. The rate of thickening increased for both AT and carotid-IMT according to age (p < 0.001). In the teens, there was no carotid-IMT thickening, but 39 % of the subjects had a thickened AT. The thresholds of cumulative LDL-C values for AT and carotid-IMT thickening based on ROC curves were 9210 mg/dL∗years (AUC: 0.66, 95 % CI: 0.61–0.72) for ATT and 11,255 mg/dL∗years (AUC: 0.79, 95 % CI: 0.75–0.84) for carotid-IMT. For cumulative LDL-C levels ≥ median, untreated HDL-C level was lower in the AT thickened group than in the non-thickened group (AT thickened: 52 (43–63) mg/dL, non-thickened: 63 (52–72) mg/dL). There was a significant correlation between ATT and cumulative LDL-C (Male: R = 0.48 p < 0.001, Female: R = 0.33 p < 0.001). We clarified that both cumulative exposure to LDL-C and untreated HDL-C levels were closely related to AT thickening. Our results show that in ultrasonographic assessment, ATT is more useful than carotid-IMT for predicting the degree of lipid deposition in tissues, especially in young adults. [Display omitted] •We clarified that Achilles tendon (AT) thickening is influenced not only by cumulative exposure to LDL-C but also by untreated HDL-C levels.•The threshold of cumulative LDL-C values for AT thickening was lower than that for carotid IMT thickening.•Among teenagers (10–19 years old), there were no subjects with carotid IMT thickening, while 39 % of subjects had a thickened AT.•Especially in young adults, AT thickness is more useful than carotid IMT for predicting the degree of lipid deposition in tissues.