Tendon Pathology in Hypercholesterolemia and Familial Hypercholesterolemia

Taylor, Brittany L.; Cheema, Adnan N.; Soslowsky, Louis J.

doi:10.1007/s11926-017-0704-2

Cited by 23 publications

(19 citation statements)

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“…Importantly, this animal model did not induce a diabetic or hypercholesterolemic phenotype, both of which have been shown to impair tendon healing and are often concurrent with obesity/metabolic syndrome. 41,50 Therefore, this study provides a preclinical model that demonstrates the influence of obesity independent of associated comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Obesity Impairs Enthesis Healing After Rotator Cuff Repair in a Rat Model

et al. 2021

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Background: Being overweight or obese is associated with poor outcomes and an increased risk of failure after rotator cuff (RC) surgery. However, the effect of obesity on enthesis healing has not been well characterized. Hypotheses: Diet-induced obesity (DIO) would result in inferior enthesis healing in a rat model of RC repair, and a dietary intervention in the perioperative period would improve enthesis healing. Study Design: Controlled laboratory study. Methods: Male Sprague-Dawley rats were divided into 3 weight-matched groups (n = 26 per group): control diet (CD), high-fat diet (HFD), or HFD until surgery and then CD thereafter (HF-CD). After 12 weeks, the left supraspinatus tendon was detached, followed by immediate repair. Animals were sacrificed, and RCs were harvested at 2 and 12 weeks after surgery for biomechanical and histological evaluations. Metabolic end points were assessed using dual-energy X-ray absorptiometry and plasma analyses. Results: DIO was established in the HFD and HF-CD groups before surgery and subsequently reversed in the HF-CD group after surgery. At 12 weeks after surgery, the body fat percentage ( P = .0021) and plasma leptin concentration ( P = .0025) were higher in the HFD group compared with the CD group. Histologically, the appearance of the repaired entheses was poorer in both the HFD and HF-CD groups compared with the CD group at 12 weeks after surgery, with semiquantitative scores of 6.20 ( P = .0078), 4.98 ( P = .0003), and 8.68 of 15, respectively. The repaired entheses in the HF-CD group had a significantly lower load to failure ( P = .0278) at 12 weeks after surgery compared with the CD group, while the load to failure in the HFD group was low but not significantly different ( P = .0960). There were no differences in the biomechanical and histological results between the groups at 2 weeks after surgery. Body mass at the time of surgery, plasma leptin concentration, and body fat percentage were negatively correlated with histology scores and plasma leptin concentration was correlated with load to failure at 12 weeks after surgery. Conclusion: DIO impaired enthesis healing in this rat RC repair model, with inferior biomechanical and histological outcomes. Restoring a normal weight with dietary changes after surgery did not improve healing outcomes. Clinical Relevance: Obesity is a potentially modifiable factor that impairs RC healing and increases the risk of failure after surgery. Exploring interventions that improve the metabolic state of obese patients and counseling patients appropriately about their modest expectations after repair should be considered.

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Section: Discussionmentioning

confidence: 99%

Obesity Impairs Enthesis Healing After Rotator Cuff Repair in a Rat Model

et al. 2021

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“…Recently, the influence of hypercholesterolaemia on musculoskeletal system has attracted much attention. In hypercholesterolaemia environments, lipids could accumulate within the extracellular matrix of the tendon and thus affect the mechanical properties of the tendon [5], [6]. Several studies have explored the relationship between hypercholesterolaemia and tendon pathology.…”

Section: Introductionmentioning

confidence: 99%

Tendon pathology in hypercholesterolaemia patients: Epidemiology, pathogenesis and management

Yang

2019

Journal of Orthopaedic Translation

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Tendon pathology is a general term used to describe a group of musculoskeletal conditions related to tendons and surrounding structures. There is only limited evidence available regarding the exact aetiology and natural history of tendon pathology. In hypercholesterolaemia environments, lipids could accumulate within the extracellular matrix of the tendon and thus affect the mechanical properties of the tendon. Current evidence suggested that hypercholesterolaemia was an important risk factor in the development and progression of tendon pathology. The severity of hypercholesterolaemia was correlated with the severity of tendon pathology.The translational potential of this article: Hypercholesterolaemia lead to the structural, inflammatory and mechanical changes in tendons, which predispose hypercholesterolaemia patients to a greater risk of tendon pathology. Measurements of serum cholesterol are suggested to be performed in patients presenting with tendon pathology. The strict control of hypercholesterolaemia would mitigate the development and progression of tendon pathology.

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“…31 Furthermore, metabolic disorders often increase the production of proinflammatory cytokines and matrix destruction via matrix metalloproteinases, which can impair the tendon healing environment. 26 However, the detrimental effect of nonfamilial hypercholesterolemia and the mechanism by which it affects tendon pathology remain debatable. 4 Therefore, we expect that our findings from this nationwide general population study will be beneficial for future researchers, although we did not separate the results based on the existence of familial hypercholesterolemia.…”

Section: Discussionmentioning

confidence: 99%

Dyslipidemia Is Associated With Increased Risk of Achilles Tendon Disorders in Underweight Individuals to a Greater Extent Than Obese Individuals: A Nationwide, Population-Based, Longitudinal Cohort Study

Ahn

Kim

Kang

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: The association between dyslipidemia and Achilles tendinopathy (AT) or Achilles tendon rupture (ATR) remains controversial, although some studies have examined this topic. Purpose: 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. Study Design: Cohort study; Level of evidence, 3. Methods: We used the National Health Insurance database, which includes the entire population of the Republic of Korea, to evaluate participants in the National Health Screening Program between January 2009 and December 2010. Participants diagnosed with AT or ATR before December 31, 2017, were selected. The variables assessed were age, sex, frequency of high-intensity exercise per week, BMI, waist circumference, systolic blood pressure, and levels of low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and fasting blood glucose. Multivariate Cox proportional hazards regression was used for data analysis. Results: A total of 16,830,532 participants were included. Of these, 125,814 and 31,424 participants developed AT and ATR, respectively. A higher level of LDL-C was associated with an increased risk of AT (adjusted hazard ratio [HR], 1.16) and ATR (adjusted HR, 1.18). A slightly increased risk of AT was observed in participants 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 level was associated with an increased risk of AT and ATR by 10% and 16%, respectively, in the obese group (BMI ≥25 kg/m2). Conclusion: 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 individuals.

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Tendon Pathology in Hypercholesterolemia and Familial Hypercholesterolemia

Cited by 23 publications

References 50 publications

Obesity Impairs Enthesis Healing After Rotator Cuff Repair in a Rat Model

Obesity Impairs Enthesis Healing After Rotator Cuff Repair in a Rat Model

Tendon pathology in hypercholesterolaemia patients: Epidemiology, pathogenesis and management

Dyslipidemia Is Associated With Increased Risk of Achilles Tendon Disorders in Underweight Individuals to a Greater Extent Than Obese Individuals: A Nationwide, Population-Based, Longitudinal Cohort Study

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