Background Tendon xanthomas, manifested as Achilles tendon (AT) thickening (ATT) or structural abnormalities, share pathogenic mechanisms with atherosclerosis such as cumulative exposure to low-density lipoprotein cholesterol; however, their association with the severity of systemic atherosclerosis remains unclear. This study sought to investigate the association between AT abnormalities assessed by ultrasound and the prevalence and severity of polyvascular disease (PVD) in patients undergoing percutaneous coronary intervention (PCI). Methods This cross-sectional analysis used baseline data from a prospective multicenter observational study (Achilles Study: UMIN000053786). AT thickness and structural abnormalities were evaluated using ultrasonography. ATT was defined as ≥6.0 mm in men and ≥ 5.5 mm in women. AT structural abnormalities were defined as the presence of calcification, abnormal layer structure, or localized hypoechogenicity. Results Among 333 patients (median age 75 years; 83% male), ATT was observed in 109 patients (33%), and AT structural abnormalities were identified exclusively in patients with ATT (14%). The prevalence of PVD increased stepwise across patients with no AT abnormalities, those with ATT without structural abnormalities, and those with ATT with structural abnormalities (20% vs. 30% vs. 51%, p < 0.001). Maximum intima-media thickness of carotid artery and SYNTAX score were highest among patients with both ATT and structural abnormalities. These associations remained consistent in patients without familial hypercholesterolemia (FH). Conclusions AT structural abnormalities assessed by ultrasound were significantly associated with the prevalence and severity of PVD in patients undergoing PCI. Assessment of AT abnormalities may serve as a useful marker for evaluating systemic atherosclerotic burden.
Oyama et al. (Tue,) studied this question.