{
  "abstract": "Introduction Metabolic disorders have been increasingly linked to tendon pathology. This study evaluated whether individuals with metabolic risk factors have a greater risk of developing Achilles tendinopathy (AT) compared with metabolically healthy individuals using real-world electronic health record data.Materials and Methods A retrospective cohort analysis was performed using a global federated research network (TriNetX) with data from 151–158 healthcare organisations. Adults (≥18 years) with BMI>30kg/m 2 and ≥2 metabolic risk factors—hypertension, elevated HbA1c (≥5.7%), low HDL (<50mg/dL), or high triglycerides (≥150 mg/dL)-formed the metabolic cohort. Those with BMI<30 kg/m2 and no metabolic risk factors formed the non-metabolic cohort. The outcome was Achilles tendinopathy (ICD-10 M76.6) recorded within 1–1825 days after the index date. Propensity-score matching (1:1) balanced cohorts for age, sex, and ethnicity.Results Before matching, 4.56 million metabolic and 23.20 million non-metabolic patients were identified. After matching, 3,770,936 patients remained in each cohort (total 7.54 million). AT occurred in 30,462 (0.8%) metabolic versus 5,490 (0.1%) non-metabolic patients. The risk ratio was 6.76 (95% CI 6.63–6.88), and the hazard ratio was 0.31 (95% CI 0.30–0.32; p < 0.001), indicating lower survival free from AT in the metabolic cohort. Kaplan–Meier survival at 5 years was 98.9% versus 99.7%.Conclusion In this propensity-matched analysis of 7.5 million patients, those with obesity and multiple metabolic risk factors had a markedly greater risk of Achilles tendinopathy than metabolically healthy individuals. These findings highlight metabolic dysregulation as a major, potentially modifiable contributor to tendon disease and advocates for more integrated metabolic–musculoskeletal prevention strategies.",
  "authors": [
    {
      "affiliations": [
        "University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, United Kingdom",
        "East Lancashire Hospitals Trust, United Kingdom"
      ],
      "name": "Matt Kenyon"
    },
    {
      "affiliations": [
        "University of Leicester, United Kingdom"
      ],
      "name": "Joe Henson"
    },
    {
      "affiliations": [
        "University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, United Kingdom",
        "University of Liverpool, United Kingdom"
      ],
      "name": "Gashirai K Mbizvo"
    },
    {
      "affiliations": [
        "University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, United Kingdom",
        "University of Liverpool, United Kingdom",
        "The Walton Centre NHS Foundation Trust, United Kingdom"
      ],
      "name": "Saif Huda"
    },
    {
      "affiliations": [
        "University of Leicester, United Kingdom"
      ],
      "name": "Seth O’Neill"
    },
    {
      "affiliations": [
        "University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, United Kingdom",
        "Aalborg University, Denmark"
      ],
      "name": "Gregory YH Lip"
    }
  ],
  "title": "25 Metabolic versus non-metabolic profiles and risk of Achilles tendinopathy: a propensity score–matched analysis of 7.5 million patients",
  "uid": "7877243d-03d6-5fa1-b5dd-288de0262f84"
}