Abstract Background Achilles tendon xanthoma (ATX) is an important diagnostic criterion for familial hypercholesterolemia (FH) in the Japanese population. ATX, which is composed of monocyte-derived foam cells resulting from the intracellular accumulation of lipids and connective tissue, is generally dependent on the degree and duration of exposure to elevated low-density lipoprotein cholesterol (LDL-C) levels. ATX has been identified as an important risk factor for coronary artery disease (CAD) in patients with FH. However, to our knowledge, there is a paucity of studies investigating the impact of ATX on CAD severity in patients without FH. Purpose To evaluate the association between Achilles tendon (AT) thickness and CAD severity among patients without FH. Methods We enrolled consecutive patients who underwent percutaneous coronary intervention (PCI) between May 2023 and January 2025. AT thickness was measured by ultrasound according to the method outlined in the guidelines proposed by the Japan Atherosclerosis Society. The threshold for ATX diagnosis was 6.0 mm in men and 5.5 mm in women. The SYNTAX score was calculated based on the findings of the coronary angiography before PCI. We assessed the impact of AT thickness on the SYNTAX score. Results A total of 138 eligible patients (mean age, 73.5 ± 11.2 years; 82% male) were evaluated. The median AT thickness was 5.4 (5.1–6.0) mm. ATX was observed in 46 (33%) patients. Patients were divided into two the following groups based on the presence of ATX: the ATX group (n = 46) and the non-ATX group (n = 92). Although no statistically significant differences were observed in lipid profiles between both groups, the ATX group showed a higher prevalence of acute coronary syndrome, polyvalvular disease, and multivessel CAD (Figure 1). The SYNTAX score was significantly higher in the ATX group than in the non-ATX group (22.0 ± 7.0 vs. 14.9 ± 8.7, p 0.001). AT thickness showed a strong correlation with the SYNTAX score (r = 0.317, p 0.001). However, the LDL-C values showed no association with AT thickness and the SYNTAX score (r = 0.023, p = 0.785; r = 0.015, p = 0.866, respectively). In the multivariate regression analysis, AT thickness remained an independent predictor of CAD severity based on the SYNTAX score after adjusting for traditional coronary risk factors (Figure 2). Conclusions AT thickness was strongly correlated with CAD severity in patients undergoing PCI without FH. ATX was identified as a major risk factor for atherosclerotic cardiovascular disease. AT thickness seemed to be a suitable predictor of atherosclerosis and CAD progression.
Oyama et al. (Sat,) studied this question.