Risk Assessment for Cardiovascular Events using Achilles Tendon Thickness and Softness and Intima-Media Thickness in...

Area of Science:

• Cardiovascular Medicine
• Radiology
• Genetics

Background:

• Heterozygous familial hypercholesterolemia (HeFH) is a genetic condition leading to elevated LDL cholesterol and increased risk of cardiovascular disease.
• Early identification and risk stratification are crucial for managing HeFH patients to prevent major adverse cardiovascular events (MACEs).
• Novel imaging biomarkers are needed to improve cardiovascular risk assessment in HeFH.

Purpose of the Study:

• To determine cutoff values for Achilles tendon thickness (ATT) and carotid intima-media thickness (C-IMT) for predicting MACEs in HeFH patients.
• To evaluate the effectiveness of ATT (ultrasonography and radiography) and C-IMT as risk assessment indexes.
• To assess the role of Achilles tendon calcification in MACE risk stratification.

Main Methods:

• Retrospective cohort study of 391 clinically diagnosed HeFH patients.
• ROC curve analysis to determine cutoff values for ultrasonography-measured ATT (US-ATT), radiography-measured ATT (Xp-ATT), and C-IMT.
• Kaplan-Meier curves and multivariate analysis to assess the predictive value of these indexes and AT calcification for MACEs.

Main Results:

• Cutoff values for MACEs were established: US-ATT (9.9 mm males, 7.1 mm females) and C-IMT (1.6 mm males, 1.5 mm females).
• Higher US-ATT, AT softening, AT calcification, and greater C-IMT were significantly associated with increased MACE rates (P<0.001).
• Xp-ATT did not show a significant difference in MACE rates (P=0.112).

Conclusions:

• Established thresholds for US-ATT and C-IMT, along with AT calcification assessment, can enhance cardiovascular risk stratification in HeFH patients.
• These imaging markers can guide more intensive management strategies for high-risk HeFH individuals.
• Ultrasonography of the Achilles tendon shows promise as a non-invasive tool for cardiovascular risk assessment in HeFH.