J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://jocmr.elmerjournals.com

Original Article

Volume 18, Number 9, September 2026, pages 632-642

Significant Associations of Achilles Tendon Thickness With Atherosclerotic Diseases and Atherosclerotic Risk Factors in Non-Familial Hypercholesterolemia Patients: A Cross-Sectional Study

↓ Figure 1. Achilles tendon thickness in patients with and without coronary artery disease in all patients (a), in patients ≥ 65 years old and patients < 65 years old (b), in male and female patients (c), and in patients treated with statins and patients untreated with statins (d). Error bars indicate mean ± SE. *P < 0.01 vs. patients without coronary artery disease. SE: standard error.

↓ Figure 2. Achilles tendon thickness in patients with and without cerebrovascular disease in all patients (a), in patients ≥ 65 years old and patients < 65 years old (b), in male and female patients (c), and in patients treated with statins and patients untreated with statins (d). Error bars indicate mean ± SE. SE: standard error.

↓ Figure 3. Achilles tendon thickness in patients with and without carotid artery stenosis in all patients (a), in patients ≥ 65 years old and patients < 65 years old (b), in male and female patients (c), and in patients treated with statins and patients untreated with statins (d). Error bars indicate mean ± SE. *P < 0.01 vs. patients without carotid artery stenosis. SE: standard error.

↓ Figure 4. Achilles tendon thickness in patients with and without diabetes in all patients (a), in patients ≥ 65 years old and patients < 65 years old (b), in male and female patients (c), and in patients treated with statins and patients untreated with statins (d). Error bars indicate mean ± SE. *P < 0.01 vs. patients without diabetes. SE: standard error.

↓ Figure 5. Achilles tendon thickness in patients with and without coronary artery disease (a), cerebrovascular disease (b), and carotid artery stenosis (c) in patients with diabetes. Error bars indicate mean ± SE. *P < 0.01 vs. patients without coronary artery disease (a) and without carotid artery disease (c). SE: standard error.

↓ **Table 1.** Clinical Characteristics of the Studied Patients
Clinical characteristics
Values are expressed as mean ± SD. BMI: body mass index; SD: standard deviation.
Age (years)	64 ± 14
Gender (male/female)	512/488
Body height (cm)	161 ± 10
Body weight (kg)	64 ± 16
BMI (kg/m²)	24.6 ± 4.9
Systolic blood pressure (mm Hg)	131 ± 20
Diastolic blood pressure (mm Hg)	77 ± 13
Comorbidities
Coronary artery disease (n, %)	88/998, 8.8
Cerebrovascular disease (n, %)	152/998, 15.2
Carotid artery stenosis (n, %)	114/1,000, 11.4
Diabetes (n, %)	643/997, 64.0

↓ Table 1. Clinical Characteristics of the Studied Patients

Clinical characteristics

Values are expressed as mean ± SD. BMI: body mass index; SD: standard deviation.

Age (years)

64 ± 14

Gender (male/female)

512/488

Body height (cm)

161 ± 10

Body weight (kg)

64 ± 16

BMI (kg/m²)

24.6 ± 4.9

Systolic blood pressure (mm Hg)

131 ± 20

Diastolic blood pressure (mm Hg)

77 ± 13

Comorbidities

Coronary artery disease (n, %)

88/998, 8.8

Cerebrovascular disease (n, %)

152/998, 15.2

Carotid artery stenosis (n, %)

114/1,000, 11.4

Diabetes (n, %)

643/997, 64.0

↓ **Table 2.** Pharmacotherapies for Dyslipidemia, Hypertension, and Diabetes
Pharmacotherapies
α-GIs: α-glucosidase inhibitors; CCBs: calcium channel blockers; DPP4: dipeptidyl peptidase 4; GLP-1RAs: glucagon-like peptide 1 receptor agonists; MRAs: mineralocorticoid receptor antagonists; RAS: renin-angiotensin system; SGLT2: sodium-glucose co-transporter 2.
Anti-hyperlipidemic drugs
Statins	353 (37%)
Fibrates	55 (6%)
Omega-3 fatty acids	47 (5%)
Ezetimibe	64 (7%)
Probucol	1 (0.1%)
Anti-hypertensive drugs
RAS inhibitors	277 (29%)
CCBs	302 (31%)
β-blockers	73 (8%)
α-blockers	14 (1%)
MRAs	28 (3%)
Diuretics	52 (5%)
Anti-diabetic drugs
Biguanide	217 (23%)
DPP4 inhibitors	270 (28%)
SGLT2 inhibitors	192 (20%)
GLP-1RAs	59 (6%)
Thiazolidinediones	66 (7%)
α-GIs	48 (5%)
Insulin	115 (12%)

↓ Table 2. Pharmacotherapies for Dyslipidemia, Hypertension, and Diabetes

Pharmacotherapies

α-GIs: α-glucosidase inhibitors; CCBs: calcium channel blockers; DPP4: dipeptidyl peptidase 4; GLP-1RAs: glucagon-like peptide 1 receptor agonists; MRAs: mineralocorticoid receptor antagonists; RAS: renin-angiotensin system; SGLT2: sodium-glucose co-transporter 2.

Anti-hyperlipidemic drugs

Statins

353 (37%)

Fibrates

55 (6%)

Omega-3 fatty acids

47 (5%)

Ezetimibe

64 (7%)

Probucol

1 (0.1%)

Anti-hypertensive drugs

RAS inhibitors

277 (29%)

CCBs

302 (31%)

β-blockers

73 (8%)

α-blockers

14 (1%)

MRAs

28 (3%)

Diuretics

52 (5%)

Anti-diabetic drugs

Biguanide

217 (23%)

DPP4 inhibitors

270 (28%)

SGLT2 inhibitors

192 (20%)

GLP-1RAs

59 (6%)

Thiazolidinediones

66 (7%)

α-GIs

48 (5%)

Insulin

115 (12%)

↓ **Table 3.** Ultrasonographic Measurements of the Carotid Artery and Achilles Tendon and Biochemical Data
Ultrasonographic measurements
Values are expressed as mean ± SD. HbA1c: hemoglobin A1c; HDL-C: high-density lipoprotein-cholesterol; IMT: intima-media thickness; LDL-C: low-density lipoprotein-cholesterol; SD: standard deviation.
Maximal IMT of carotid artery (mm)	1.8 ± 1.0
Achilles tendon thickness (mm)	4.6 ± 0.8
Biochemical data
LDL-C (mg/dL)	115 ± 39
HDL-C (mg/dL)	54 ± 17
Triglyceride (mg/dL)	145 ± 90
Non-HDL-C	142 ± 43
Plasma glucose (mg/dL)	167 ± 92
HbA1c (%)	8.2 ± 2.7

↓ Table 3. Ultrasonographic Measurements of the Carotid Artery and Achilles Tendon and Biochemical Data

Ultrasonographic measurements

Values are expressed as mean ± SD. HbA1c: hemoglobin A1c; HDL-C: high-density lipoprotein-cholesterol; IMT: intima-media thickness; LDL-C: low-density lipoprotein-cholesterol; SD: standard deviation.

Maximal IMT of carotid artery (mm)

1.8 ± 1.0

Achilles tendon thickness (mm)

4.6 ± 0.8

Biochemical data

LDL-C (mg/dL)

115 ± 39

HDL-C (mg/dL)

54 ± 17

Triglyceride (mg/dL)

145 ± 90

Non-HDL-C

142 ± 43

Plasma glucose (mg/dL)

167 ± 92

HbA1c (%)

8.2 ± 2.7

↓ **Table 4.** Correlations of Achilles Tendon Thickness With Carotid Artery IMT and Metabolic Parameters in All Patients (n = 1,000)
	Correlation coefficient	P values
Values are expressed as mean ± SD. BMI: body mass index; HbA1c: hemoglobin A1c; HDL-C: high-density lipoprotein-cholesterol; IMT: intima-media thickness; LDL-C: low-density lipoprotein-cholesterol; SD: standard deviation.
Maximal carotid IMT	0.09	0.005
Age	−0.001	0.983
Body weight	0.28	< 0.001
BMI	0.18	< 0.001
Systolic blood pressure	0.05	0.131
Diastolic blood pressure	0.06	0.084
LDL-C	−0.05	0.206
HDL-C	−0.18	< 0.001
Triglyceride	0.06	0.066
Non-HDL-C	−0.04	0.239
Plasma glucose	0.04	0.240
HbA1c	0.01	0.766

↓ Table 4. Correlations of Achilles Tendon Thickness With Carotid Artery IMT and Metabolic Parameters in All Patients (n = 1,000)

Correlation coefficient

P values

Values are expressed as mean ± SD. BMI: body mass index; HbA1c: hemoglobin A1c; HDL-C: high-density lipoprotein-cholesterol; IMT: intima-media thickness; LDL-C: low-density lipoprotein-cholesterol; SD: standard deviation.

Maximal carotid IMT

0.09

0.005

Age

−0.001

0.983

Body weight

0.28

< 0.001

BMI

0.18

< 0.001

Systolic blood pressure

0.05

0.131

Diastolic blood pressure

0.06

0.084

LDL-C

−0.05

0.206

HDL-C

−0.18

< 0.001

Triglyceride

0.06

0.066

Non-HDL-C

−0.04

0.239

Plasma glucose

0.04

0.240

HbA1c

0.01

0.766

↓ **Table 5.** Correlations of Achilles Tendon Thickness With Carotid Artery IMT and Metabolic Parameters in Patients With Diabetes (n = 643)
	Correlation coefficient	P values
Values are expressed as mean ± SD. BMI: body mass index; HbA1c: hemoglobin A1c; HDL-C: high-density lipoprotein-cholesterol; IMT: intima-media thickness; LDL-C: low-density lipoprotein-cholesterol; SD: standard deviation.
Maximal carotid IMT	0.12	0.002
Age	0.003	0.939
Body weight	0.26	< 0.001
BMI	0.16	< 0.001
Systolic blood pressure	0.06	0.120
Diastolic blood pressure	0.07	0.095
LDL-C	0.01	0.868
HDL-C	−0.14	< 0.001
Triglyceride	0.08	0.832
Non-HDL-C	−0.04	0.282
Plasma glucose	0.02	0.651
HbA1c	−0.06	0.170

↓ Table 5. Correlations of Achilles Tendon Thickness With Carotid Artery IMT and Metabolic Parameters in Patients With Diabetes (n = 643)

Correlation coefficient

P values

Maximal carotid IMT

0.12

0.002

Age

0.003

0.939

Body weight

0.26

< 0.001

BMI

0.16

< 0.001

Systolic blood pressure

0.06

0.120

Diastolic blood pressure

0.07

0.095

LDL-C

0.01

0.868

HDL-C

−0.14

< 0.001

Triglyceride

0.08

0.832

Non-HDL-C

−0.04

0.282

Plasma glucose

0.02

0.651

HbA1c

−0.06

0.170