Original Article
Is There a Relation Between Lateral Epicondylitis and Total Cholesterol Levels?

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Purpose

To investigate whether high total cholesterol (TC) levels are associated with lateral epicondylitis (LE).

Methods

We retrospectively reviewed all patients with LE who presented to our institution between 2011 and 2015. The inclusion criteria were a diagnosis of LE based on clinical history and physical examination findings and age between 40 and 55 years. For healthy controls, we obtained data from a national cohort (sixth Korean National Health and Nutrition Examination Survey) aged between 40 and 55 years. We compared TC levels between the groups, determined the incidence of hypercholesterolemia (TC level ≥ 240 mg/dL) according to the occurrence of LE, and calculated odds ratios for the occurrence of LE. We also evaluated whether cholesterol levels were associated with clinical findings of LE, such as pain level, onset age, symptom duration, and number of corticosteroid injections.

Results

The study comprised 289 patients with LE (mean age, 47.9 years) and 1,077 healthy individuals (mean age, 47.7 years). TC levels were significantly higher in patients with LE than in healthy individuals (205.0 mg/dL vs 194.6 mg/dL, P < .001). The mean difference of 10.4 mg/dL was clinically meaningful because a change of 10 mg/dL with medical intervention is considered significant. The incidence of hypercholesterolemia was higher in LE patients than in healthy controls (16.6% vs 9.0%, P < .001). After adjustment for age, sex, body mass index, and glucose level, patients with hypercholesterolemia (TC level ≥ 240 mg/dL) were 2.47 (95% confidence interval, 1.65-3.70) times more likely to experience LE than those with normal cholesterol levels (<200 mg/dL). TC levels correlated with pain level, onset age, and number of corticosteroid injections.

Conclusions

A clinically meaningful difference in TC levels was found between LE patients and healthy controls. In addition, the incidence of hypercholesterolemia was higher in LE patients than in controls. The present findings suggest a potential association between high TC levels and LE.

Level of Evidence

Level III, case-control study.

Section snippets

Subjects

We obtained approval from the institutional review board at our institution. This study was a retrospective review of patients with LE who had visited our clinic, which is a tertiary referral hospital, between 2011 and 2015. The inclusion criterion was a diagnosis of unilateral LE based on clinical history and physical examination findings when all 3 of the following features were present: pain on the lateral side of the elbow, pain at the lateral epicondyle region on resisted extension of the

Comparison of Demographic and Laboratory Findings Between LE and Control Groups

Among 357 patients with LE, 13 were excluded because of abnormal findings on radiographs (calcification in 5, arthritic changes in 2, and fracture sequelae in 6) and 55 were excluded because of concomitant conditions (rotator cuff syndrome in 24, tenosynovitis in 16, carpal tunnel syndrome in 10, and previous elbow surgery in 5). Finally, 289 patients were enrolled based on application of the exclusion criteria. There were 114 men and 175 women, and the mean age at the time of diagnosis was

Discussion

In this study, patients with LE had higher TC levels than the healthy control group. The incidence of hypercholesterolemia was also higher in LE patients than in healthy controls. In addition, subjects with hypercholesterolemia were more likely to experience LE than those with normal cholesterol levels after adjustment for BMI and glucose levels. Moreover, a dose-response gradient was found between cholesterol level category and the risk of LE.

Previous studies reported an association between

Conclusions

A clinically meaningful difference in TC levels was found between LE patients and healthy controls. In addition, the incidence of hypercholesterolemia was higher in LE patients than in controls. The present findings suggest a potential association between high TC levels and LE.

Acknowledgment

The authors thank Jeong Su Park, M.D., Ph.D., and Youngwon Nam, M.D., from the Department of Laboratory Medicine at our hospital for their help in the interpretation of the laboratory results.

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    The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

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