Regression of Achilles tendon thickness after statin treatment in patients with familial hypercholesterolemia: an ultrasonographic study

Atherosclerosis. 2009 Jul;205(1):151-5. doi: 10.1016/j.atherosclerosis.2008.10.032. Epub 2008 Nov 11.


Objective: Achilles tendon xanthomas (ATX) have been associated with increased cardiovascular risk in patients with familial hypercholesterolemia (FH). The aim of this study was to evaluate clinical and ultrasonographic changes of ATX in patients with FH under statin treatment.

Methods: Achilles tendon thickness (ATT) and echostructure were studied by ultrasonography (US) in 80 unrelated heterozygous FH patients and in 80 age- and sex-matched controls. For ATT measurements the anterioposterior diameter (mm) of the Achilles tendon was measured on sagittal scans. Patients were treated with atorvastatin (mean dose 20+/-10mg/day) and a follow-up examination was performed 12 months later.

Results: Clinical examination revealed xanthomas in 15 patients. On US normal fibrillar echostructure (grade 1) of the Achilles tendon (AT) was observed in 42 patients, abnormal echostructure with diffuse heterogeneous echo pattern (grade 2) in 30 patients and focal hypoechoic lesions (grade 3) in 8 patients. At baseline, ATT of all patients (5.23+/-0.91 mm) was significantly larger compared with controls (4.20+/-0.70 mm) (p<0.05). Patients with grades 2 (5.20+/-0.60 mm) and 3 (6.98+/-1.07 mm) had significantly larger ATT than those with grade 1 (4.90+/-0.55 mm), p<0.05. Patients with grade 1 showed significant reduction in ATT after statin treatment (from 4.90+/-0.55 mm to 4.50+/-0.43 mm, p<0.01). In patients with grades 2 and 3 abnormal echostructure remained unchanged and no significant reduction in ATT was observed.

Conclusion: Statin treatment reduces ATT in FH patients with normal AT echostructure. Ultrasound detects AT structural involvement and is useful in the monitoring of response to treatment.

MeSH terms

  • Achilles Tendon / pathology*
  • Adult
  • Atherosclerosis / diagnosis
  • Atherosclerosis / pathology
  • Atorvastatin
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / diagnosis
  • Female
  • Heptanoic Acids / pharmacology
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Hypercholesterolemia / complications
  • Hypercholesterolemia / drug therapy*
  • Hypercholesterolemia / genetics
  • Male
  • Middle Aged
  • Pyrroles / pharmacology
  • Risk
  • Ultrasonography / methods
  • Xanthomatosis / diagnosis*
  • Xanthomatosis / pathology*


  • Heptanoic Acids
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Pyrroles
  • Atorvastatin