High cholesterol is medically recognised as a condition with no clinical manifestations, meaning it can only be diagnosed when evidence from a blood test has been obtained. The longer the condition is left undiagnosed, however, the more lipids build-up in the tendons. This could eventually lead to the formation of papules on several parts of the body, according to several health bodies.
Tendon xanthomas are caused by a build-up of cholesterol deposits in the tendon due to low-density lipoprotein (LDL) cholesterol regulation.
The condition is caused by impairment in the regulation of lipoprotein which results in “accumulated cholesterol deposits in the tendons and ligaments”, according to Case Reports in Dermatology.
There is substantial evidence that the lipids found within these xanthomas are the same as the lipid circulating in the blood of patients.
However, it remains unclear which mechanisms exactly induce xanthoma formation.
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According to the Dermatology Advisor, small tendon xanthomas are asymptomatic and tend to grow over the course of decades.
In fact, patients will tend to remain unaware of their presence, and the lesions may only become apparent by palpitation.
The slowly enlarging subcutaneous nodules can form in several places, but some body parts are more likely to be affected than others.
Tendon xanthomas tend to form over the Achilles tendons, hands and surfaces of the elbows and knees, according to Karger.
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Sometimes, they appear on the fingers.
The growths tend to have a smooth surface, are firm to the touch, and have overlying skin that is a normal colour.
The Dermatology Advisor states that patients with familial hypercholesterolemia have a higher predisposition to tendon xanthomas.
“However, they often succumb to atherosclerotic disease before tendon xanthomas can develop,” adds the health body.
Familial hypercholesterolemia is an inherited condition where the body is unable to effectively get rid of extra LDL, causing levels to rise in the blood.
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The Cleveland Clinic states: “The first noticeable symptom of PAD may be intermittent claudication – leg discomfort, pain or cramping that develops with activity.”
The onset of peripheral artery disease before the age of 25 is extremely rare, as the condition can develop over the course of decades.
The Centre for Disease Control and Prevention says: “If you have symptoms of PAD, your doctor may do an ankle-brachial index (ABI), which is a non-invasive test that measures the blood pressure in the ankles and compared it with the blood pressure in the arms at rest and after exercise.
“Your doctor may also do imaging tests such as ultrasound, magnetic resonance hagiographic, and computed tomographic angiography.”