Blog | Thursday, June 27, 2013

Statins and exercise

Several years ago, one of my best friends complained that a statin was interfering with his exercise routine. While I believed him, I was a bit skeptical. We have known for some time that statins can impact muscles, pain and even rhabdomyolysis. But what about routine exercise?

Consider this excerpt from an article at the New York Times: Can Statins Cut the Benefits of Exercise?

"But until the current study, no experiment scrupulously had explored the interactions of statin drugs and workouts in people. And the results, as it turns out, are worrisome.

"The unmedicated volunteers improved their aerobic fitness significantly after three months of exercise, by more than 10 percent on average. But the volunteers taking the statins gained barely 1 percent on average in their fitness, and some possessed less aerobic capacity at the end of the study than at its start.

"Why there should be such a discrepancy between the two groups' fitness levels wasn't clear on the surface. But when the researchers looked microscopically at biopsied muscle tissue, they found notable differences in the levels of an enzyme related to the health of mitochondria, the tiny energy-producing parts of a cell. Mitochondria generally increase in number and potency when someone exercises.

"But in the volunteers taking statins, enzyme levels related to mitochondrial health fell by about 4.5 percent over the course of the experiment. The same levels increased by 13 percent in the group not taking the drug.

"In effect, the volunteers taking statins "were not getting the same bang from their exercise buck" as the other exercisers, says John P. Thyfault, a professor of nutrition and exercise physiology at the University of Missouri and senior author of the study."

Statins remains important medications. My enthusiasm has waned on treating patients without known atherosclerotic disease or equivalent (type II diabetes mellitus). We should use statins more sparingly, focusing on those who get enough benefit to make any potential side effects a reasonable risk.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.