Article Text

Is higher serum cholesterol associated with altered tendon structure or tendon pain? A systematic review
  1. Benjamin J Tilley1,
  2. Jill L Cook1,2,
  3. Sean I Docking1,2,
  4. James E Gaida1,3,4
  1. 1Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia
  2. 2Australian Centre of Research into Injury in Sport and its Prevention (ACRISP), Federation University, Victoria, Australia
  3. 3Discipline of Physiotherapy, University of Canberra, Canberra, Australian Capital Territory, Australia
  4. 4University of Canberra, Research Institute for Sport and Exercise (UCRISE) Canberra, Australian Capital Territory, Australia
  1. Correspondence to Benjamin J Tilley, Monash University Peninsula Campus, McMahons Road, Frankston, VIC 3199, Australia; benjaminj.tilley18{at}


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.

  • Cholesterol

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