Dyslipidemia is Associated with an Increased Risk of Achilles Tendinopathy and Tendon Rupture to a Greater Extent in Underweight Than in Obese Subjects

Abstract

Category: Ankle Introduction/Purpose: The association between dyslipidemia and Achilles tendinopathy (AT) or Achilles tendon rupture (ATR) remains controversial, although some studies have been reported on the subject. This study aimed to evaluate the correlation of dyslipidemia and the risk of AT or ATR, and its association with body mass index (BMI), by assessing data from a nationwide population-based cohort. Methods: We used the National Health Insurance database, which includes the entire South Korean population to follow-up subjects who participated in the National Health Screening Program (NHSP) from January 2009 to December 2010. Participants diagnosed with AT or ATR before December 31, 2017, were selected. The variables were age, sex, frequency of high-intensity exercise per week, BMI, waist circumference, low-density lipoprotein cholesterol (LDL-C) levels, triglyceride (TG) levels, high- density lipoprotein cholesterol (HDL-C) levels, fasting blood glucose levels, and systolic blood pressure. Multivariate Cox proportional hazards regression was used for data analysis. Results: A total of 16,830,532 subjects were included. Of these, 125,814 and 31,424 subjects developed AT and ATR, respectively. A higher level of LDL-C was associated with an increased risk of both AT (adjusted hazard ratio [HR], 1.16) and ATR (adjusted HR, 1.18). A slightly increased risk of AT was observed in subjects with higher TG levels (adjusted HR, 1.03), whereas higher HDL-C level was associated with a slight risk reduction for AT (adjusted HR, 0.95). However, no significant association was observed between higher TG or HDL-C levels and ATR. In the underweight group (BMI < 18.5 kg/m2), a higher LDL-C level was associated with an increased risk of AT and ATR by 37 and 116%, respectively, compared with lower LDL-C. Higher LDL-C levels was associated with an increased risk of AT and ATR by 10 and 16%, respectively, in the obese group (BMI >= 25 kg/m2). Conclusion: Our results support the hypothesis that dyslipidemia was related to the development of AT and ATR. The association of higher LDL-C levels with AT and ATR risk was more pronounced in underweight than in overweight and obese subjects.