title: Statins and tendinopathy: a systematic review.
abstract: OBJECTIVE
  To systematically review the evidence on whether statin therapy, commonly used in clinical practice to treat hypercholesterolaemia for primary and secondary prevention of cardiovascular disease, contributes to tendinopathy; and to examine causality according to the Bradford Hill criteria.
  
  
  METHODS
  A systematic review of studies examining the relationship between statin therapy and tendinopathy. Included studies were rated based on their methodological quality. A best evidence synthesis was used to summarise the results, and Bradford Hill criteria were used to assess causation.
  
  
  METHODS
  Ovid MEDLINE, CINAHL Plus, PubMed and Embase databases.
  
  
  METHODS
  We included adult human studies published in the English language between January 1966 and October 2015. Study designs eligible for inclusion were randomised controlled trials and cross-sectional, cohort or case-control studies.
  
  
  RESULTS
  Four studies (three cohort studies and one case-control study) were included, with a mean methodological quality score of 67%. Three studies were deemed high quality. Tendon rupture was the primary outcome in three studies, and rotator cuff disease in the other. All studies found no positive association between statin therapy and tendon rupture for the total study population. There was evidence that simvastatin reduces the risk of tendinopathy.
  
  
  CONCLUSIONS
  To date, there is a paucity of evidence to implicate statin therapy as a well established risk factor or causal mechanism for tendon rupture in the general population. There is strong evidence that simvastatin reduces the risk of tendinopathy.
authors: Baker IDI Heart and Diabetes Institute, Melbourne, VIC andrew.teichtahl@monash.edu.
authors: Andrew J
authors: AJ
authors: Teichtahl
authors: Monash University, Melbourne, VIC.
authors: Sharmayne R E
authors: SR
authors: Brady
authors: Monash University, Melbourne, VIC.
authors: Donna M
authors: DM
authors: Urquhart
authors: Monash University, Melbourne, VIC.
authors: Anita E
authors: AE
authors: Wluka
authors: Monash University, Melbourne, VIC.
authors: Yuanyuan
authors: Y
authors: Wang
authors: Baker IDI Heart and Diabetes Institute, Melbourne, VIC.
authors: Jonathan E
authors: JE
authors: Shaw
authors: Monash University, Melbourne, VIC.
authors: Flavia M
authors: FM
authors: Cicuttini
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D006937:Hypercholesterolemia / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012421:Rupture; D052256:Tendinopathy / Q000139:chemically induced*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors