Increased Achilles tendon thickness (ATT) was found to be an independent predictor of carotid atherosclerosis in patients at high or very high cardiovascular risk (CVR), according to a study published in Angiology.

In this single-center, cross-sectional study, 150 patients (ages, 40-65 years; mean age, 55 years; body mass index, 28.1 kg/m2) at high and very high CVR were recruited. Among participants considered to be at high CVR (n=86), 6 patients had a decrease in estimated glomerular filtration rate to a level ≤60 mL/min/1.73 m2, 13 had severe hypertension or hypercholesterolemia, and 67 had systemic coronary risk evaluation between 5% and 10%. A total of 64 patients were considered to be at very high CVR, of whom 61 participants had coronary artery disease, and 2 patients had type 2 diabetes mellitus with major CVR factors. Carotid and Achilles tendon ultrasounds were conducted to assess carotid plaque, percentage of stenosis, and Achilles tendon thickness (ATT).

In this cohort, 69.3% of patients had hypertension, 62.6% had abdominal obesity, 40.6% had coronary artery disease, 34.6% were obese, 22.0% previously had a myocardial infarction, and 20.6% had type 2 diabetes mellitus. Treatments included angiotensin-converting enzyme inhibitors (49.3%), beta blockers (46.0%), statins (44.0%), antiplatelets (43.3%), diuretics (16.0%), oral antidiabetic medications (14.0%), and insulin (7.3%).

Carotid atherosclerosis was detected in 78.6% of patients, and at least 50% stenosis of the carotid arteries was identified in 14.6% of participants.

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Significant correlations were detected between: ATT and carotid stenosis (r=0.277; P =.004), carotid total plaque area (r=0.305; P =.004), and carotid plaque score (r=0.225; P =.035). The average cross-sectional area of the AT correlated significantly with carotid total plaque area (r=0.316; P =.003) and carotid plaque score (r=0.282; P =.008).

An increase ≥5.07 mm in ATT was associated with a 4.55-fold increase in relative risk for carotid atherosclerosis (95% CI, 1.13-18.4; P =.033; 68.3% sensitivity; 62.5% specificity). A mean increase of 1 mm was associated with an 8.09 mm2 increase in carotid total plaque area (95% CI, 2.26-13.9; P =.007) and 4.11% increase in carotid stenosis (95% CI, 0.64-7.60; P =.021).

As the severity of atherosclerosis increased, so did the average ATT (P =.018). ATT was significantly higher among patients with carotid stenosis ≥50% (5.55 mm; range, 5.14-5.95 mm) compared with those with carotid stenosis <50% (5.03 mm; range, 4.70-5.23 mm; P =.024).

Beyond the small sample size, a major limitation of this study is a lack of standard procedure to measure ATT. Although the study design was such that a single clinician measured tendon thickness to maintain consistency, it remains unclear how reproducible these results are.

“In patients with high and very high CVR, an increase in the thickness of AT is an independent predictor of carotid atherosclerosis. The ATT directly correlates with the degree of stenosis of the carotid arteries and markers of carotid plaque burden,” concluded the study authors.


Genkel V, Kuznetsova A, Lebedev E, et al. Achilles tendon thickness is an independent predictor of carotid atherosclerosis and is associated with a carotid plaque burden. [published online June 1, 2020] Angiology. doi:10.1177/0003319720928226