March 14, 2006

Heel pain may point to cholesterol trouble

By Megan Rauscher

NEW YORK (Reuters Health) - A painful Achilles tendon could
be a sign of an inherited tendency to have high cholesterol,
which carries a high risk of early heart disease, UK
researchers say.

Wider recognition of the link between Achilles tendon pain
and so-called "heterozygous familial hypercholesterolemia" --
or HeFH -- could lead to earlier diagnosis of this disorder,
the team reports in the Annals of Rheumatic Disease.

In comments to Reuters Health, principal investigator Dr.
Paul N. Durrington from the Manchester Royal Infirmary noted
that HeFH is "the most common genetic disorder in Europe and
the USA affecting 1 in 500 people."

He explained that it is due to a mutation of a gene
controlling removal of cholesterol from the blood circulation.
"Levels of cholesterol are doubled from birth and untreated it
leads to coronary heart disease early in life. Early diagnosis
and treatment is thus important."

One feature of untreated HeFH is that cholesterol is
deposited not only in the arteries but also at certain sites in
tendons. This may lead to swelling and painful inflammation of
the Achilles tendon.

Durrington and his colleagues determined the occurrence of
Achilles tendon pain prior to diagnosis of HeFH in 133
patients, compared with the rate in 87 of their domestic

Sixty-two patients with HeFH (47 percent) had experienced
at least one episode of pain in one or both Achilles tendons
lasting more than three days, compared with only six of the
partners (7 percent).

"Our study suggests that Achilles tendon pain lasting 3
days or more is 6.75 times more likely to occur in patients
with HeFH than in the general population," the authors note.

"We discovered that patients with HeFH frequently seek
medical advice about Achilles (inflammation) many years before
they are found to have raised cholesterol," Durrington said.

He advised that anybody seeing a doctor because of a
painful Achilles tendon should have his or her cholesterol

SOURCE: Annals of Rheumatic Disease, March 2006.