A painful Achilles tendon could serve as a warning sign of an inherited tendency to have high cholesterol, which carries a high risk of early heart disease, 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.
Researcher 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 the condition 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 partners.
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 measured.