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Cholesterol level in non-insertional Achilles tendonopathy.
1Consultant Orthopaedic Surgeon, Royal National Orthopaedic Hospital, Stanmore, Middlesex HL7 4LP, United Kingdom.
Foot (Edinburgh, Scotland)
|August 16, 2015
Summary
Familial hypercholesterolaemia, a genetic disorder causing high cholesterol, is linked to Achilles tendon issues. While routine cholesterol testing for all Achilles pain isn't advised, it may benefit specific patient groups.
Area of Science:
- Medical Genetics
- Cardiovascular Medicine
- Orthopedics
Background:
- Familial hypercholesterolaemia (FH) is an autosomal dominant condition affecting 1 in 500 individuals, characterized by lipid deposits in skin, tendons, and arteries.
- FH significantly increases the risk of early coronary artery disease and mortality, but early diagnosis and cholesterol-lowering treatments improve outcomes.
- Previous studies suggest a strong association between Achilles tendon symptoms and FH, with some patients experiencing symptoms for years before diagnosis.
Purpose of the Study:
- To investigate the prevalence of heterozygous familial hypercholesterolaemia in patients presenting with non-insertional Achilles tendonopathy.
- To evaluate the clinical utility of routine serum cholesterol testing in this patient cohort.
Main Methods:
- A prospective study was conducted on consecutive patients attending an adult foot and ankle clinic with non-insertional Achilles tendonopathy between April 2012 and March 2014.
- Serum cholesterol levels were measured for all participating patients.
- Cascade testing was performed for diagnosed patients' relatives.
Main Results:
- Out of 83 patients with Achilles tendonopathy, only one (1.2%) was diagnosed with heterozygous familial hypercholesterolaemia (p=0.19).
- However, cascade testing identified three additional relatives of the proband with FH.
- The study did not find sufficient evidence to support routine cholesterol testing for all patients with Achilles tendon pain.
Conclusions:
- Routine serum cholesterol measurement in all patients with achillodynia (Achilles tendon pain) is not statistically justified based on this study's findings.
- Consideration of cholesterol testing may be warranted for patients with bilateral, extensive Achilles tendon disease or a history of intermittent, severe pain episodes.
- Early diagnosis of FH through targeted testing in specific clinical presentations remains crucial for managing cardiovascular risk.
