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. 2015 Dec;49(23):1504-9.
doi: 10.1136/bjsports-2015-095100. Epub 2015 Oct 15.

Is higher serum cholesterol associated with altered tendon structure or tendon pain? A systematic review

Benjamin J Tilley  1 , Jill L Cook  2 , Sean I Docking  2 , James E Gaida  3
Affiliations

Is higher serum cholesterol associated with altered tendon structure or tendon pain? A systematic review

Benjamin J Tilley et al. Br J Sports Med. 2015 Dec.

Abstract

Background: Tendon pain occurs in individuals with extreme cholesterol levels (familial hypercholesterolaemia). It is unclear whether the association with tendon pain is strong with less extreme elevations of cholesterol.

Objective: To determine whether lipid levels are associated with abnormal tendon structure or the presence of tendon pain.

Methods: We conducted a systematic review and meta-analysis. Relevant articles were found through an electronic search of 6 medical databases-MEDLINE, Cochrane, AMED, EMBASE, Web of Science and Scopus. We included all case-control or cross-sectional studies with data describing (1) lipid levels or use of lipid-lowering drugs and (2) tendon structure or tendon pain.

Results: 17 studies (2612 participants) were eligible for inclusion in the review. People with altered tendon structure or tendon pain had significantly higher total cholesterol, low-density lipoprotein cholesterol and triglycerides, as well as lower high-density lipoprotein cholesterol; with mean difference values of 0.66, 1.00, 0.33, and -0.19 mmol/L, respectively.

Conclusions: The results of this review indicate that a relationship exists between an individual's lipid profile and tendon health. However, further longitudinal studies are required to determine whether a cause and effect relationship exists between tendon structure and lipid levels. This could lead to advancement in the understanding of the pathoaetiology and thus treatment of tendinopathy.

Keywords: Cholesterol.

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Figures

Figure 1
Figure 1
Flow chart of search yield and study selection.
Figure 2
Figure 2
Forest plot showing the relationship between total cholesterol levels and tendon pathology (TC, total cholesterol).
Figure 3
Figure 3
Forest plot showing the relationship between high-density lipoprotein cholesterol levels and tendon pathology (HDL-C, high-density lipoprotein cholesterol).
Figure 4
Figure 4
Forest plot showing the relationship between low-density lipoprotein cholesterol levels and tendon pathology (LDL-C, low-density lipoprotein cholesterol).
Figure 5
Figure 5
Forest plot showing the relationship between triglyceride levels and tendon pathology (TG, triglycerides).
Figure 6
Figure 6
Achilles tendon thickness (ATT) mean (SD).
Figure 7
Figure 7
Total cholesterol (TC) mean (SD).
Figure 8
Figure 8
High-density lipoprotein cholesterol (HDL-C) mean (SD).
Figure 9
Figure 9
Low-density lipoprotein cholesterol (LDL-C) mean (SD).
Figure 10
Figure 10
Triglycerides (TG) mean (SD).
See this image and copyright information in PMC

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