title: Is higher serum cholesterol associated with altered tendon structure or tendon pain? A systematic review.
abstract: 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.
authors.affiliation: Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Tilley
authors.affiliation: Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia Australian Centre of Research into Injury in Sport and its Prevention (ACRISP), Federation University, Victoria, Australia.
authors.forename: Jill L
authors.initials: JL
authors.lastname: Cook
authors.affiliation: Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia Australian Centre of Research into Injury in Sport and its Prevention (ACRISP), Federation University, Victoria, Australia.
authors.forename: Sean I
authors.initials: SI
authors.lastname: Docking
authors.affiliation: Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia Discipline of Physiotherapy, University of Canberra, Canberra, Australian Capital Territory, Australia University of Canberra, Research Institute for Sport and Exercise (UCRISE) Canberra, Australian Capital Territory, Australia.
authors.forename: James E
authors.identifier: http://orcid.org/0000-0002-4504-9188
authors.initials: JE
authors.lastname: Gaida
mesh_terms: D002784:Cholesterol / Q000378:metabolism*; D005260:Female; D006801:Humans; D050356:Lipid Metabolism / Q000502:physiology; D008297:Male; D059352:Musculoskeletal Pain / Q000097:blood* / Q000473:pathology; D010147:Pain Measurement; D012727:Sex Characteristics; D052256:Tendinopathy / Q000097:blood* / Q000473:pathology; D013708:Tendon Injuries / Q000097:blood / Q000473:pathology; D013710:Tendons / Q000473:pathology*; D014280:Triglycerides / Q000378:metabolism
chemical_list: D014280:Triglycerides; D002784:Cholesterol
keywords: Cholesterol