Impact of changes of Achilles tendon thickening on cardiovascular events among patients with familial hypercholesterolemia

Abstract Backgrounds Achilles tendon thickening (ATT) can be regressed through LDL-lowering in patients with familial hypercholesterolemia (FH). The Japan Atherosclerosis Society (JAS) determined the threshold of ATT as ≥8.0 mm in male and ≥7.5 mm in female. Purpose We aimed to determine clinical impact of changes of ATT in development of major adverse cardiovascular events (MACE). Methods Patients with clinically diagnosed FH (N=1,273, male/female=614/659) with ATT data using X-ray were assessed. We divided the patients into 4 groups (group 1: patients without ATT from baseline to their follow-up, group 2: patients without ATT at baseline, but developed ATT at follow-up, group 3: patients with ATT at baseline, but regressed at follow-up, group 4: patients with ATT from baseline to their follow-up). Cox proportional hazards models were used to assess factors associated with MACE, including cardiovascular death and any coronary events. Results The median follow-up period was 10.9 years. During the follow-up period, 142 MACEs were observed, and median ATT was regressed from 7.8 to 7.6 mm. We found that there was more significant positive correlation between cholesterol-year score and ATT among patients with and without MACE (p <0.001; Spearman’s r=0.33, and p <0.001; Spearman’s r=0.35, respectively). Under these circumstances, changes of ATT were significantly associated with the occurrence of MACE (hazard ratio (HR): 2.73; 95% confidence interval (CI): 1.33–4.13; p<0.001, HR: 2.18; 95% CI: 1.08–3.28; p<0.001, HR: 6.34; 95% CI: 3.10–9.58; p<0.001, in group 2, group 3, and group 4, respectively when group 1 was considered as reference). Conclusion Assessments of ATT condition represent diagnostic values and risk stratification information among patients with FH.