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Association between Achilles tendon xanthoma and severity of coronary artery disease in patients undergoing

Hideki Kitahara1, Takashi Nakayama1, Yoshihide Fujimoto1

  • 1Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.

Journal of Cardiology
|January 30, 2020
PubMed

Insights

Achilles tendon xanthoma (ATX) is linked to more severe coronary artery disease (CAD) in patients undergoing percutaneous coronary intervention. Detecting ATX can help identify individuals with advanced CAD, beyond its role in diagnosing familial hypercholesterolemia.

Area of Science:

  • Cardiology
  • Genetics
  • Radiology

Background:

  • Achilles tendon xanthoma (ATX) is a key diagnostic sign for familial hypercholesterolemia (FH).
  • Some patients with ATX do not meet FH diagnostic criteria, suggesting other clinical implications.
  • The association between ATX and coronary artery disease (CAD) severity requires further investigation.

Purpose of the Study:

  • To evaluate the relationship between ATX and the severity of CAD in patients undergoing percutaneous coronary intervention (PCI).
  • To determine if ATX is an independent predictor of advanced CAD.

Main Methods:

  • 394 patients with CAD undergoing PCI were analyzed.
  • Achilles tendon thickness was measured using soft X-ray radiography; ATX was defined as ≥9 mm thickness.
  • CAD severity was quantified using the SYNTAX score.

Main Results:

  • 43 patients (10.9%) had ATX; 16 (4.1%) were diagnosed with FH.
  • The ATX group exhibited higher BMI, lower HDL cholesterol, and increased prevalence of FH, diabetes, and prior cardiovascular events.
  • Patients with ATX had significantly higher SYNTAX scores and a greater likelihood of severe CAD (SYNTAX score ≥23) compared to those without ATX.
  • A progressive increase in SYNTAX score and severe CAD prevalence was observed with increasing Achilles tendon thickness.
  • Male sex, diabetes, and ATX were identified as independent predictors of higher SYNTAX scores.

Conclusions:

  • ATX is independently associated with increased CAD severity in patients undergoing PCI.
  • Identifying ATX can aid in diagnosing FH and, importantly, in detecting patients with advanced coronary artery disease.
Abstract

Keywords:
Achilles tendon xanthomaCoronary artery diseaseFamilial hypercholesterolemia

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