Is moderate exercise for statin users safe?

In Australia, there are currently 2.5 million people using statins to help lower their low-density lipoprotein (LDL) cholesterol levels and prevent cardiovascular disease (CVD) events.
 
Muscle pain is among the most common side effects, which can lead to some people avoiding exercise for fear of worsening the pain.
 
While there is evidence that vigorous exercise can increase muscle damage in some statin users, which can lead to decreased physical activity or people to stop taking their medication, recent research on moderate-intensity is more reassuring.
 
The study, published in the Journal of the American College of Cardiology, has found that for those who engage in moderate exercise – such as walking – statin therapy does not exacerbate muscle injury, pain or fatigue.
 
Featuring 100 participants aged 55–73, the research compared the impact of moderate exercise on muscle injury in symptomatic and asymptomatic statin users, who had been on the medication for at least three months, and non-statin controls.
 
All participants walked 30, 40 or 50 km daily, for four consecutive days, at a self-selected pace, with muscle injury markers, muscle performance, and reported muscle symptoms assessed both at baseline and after exercise.
 
The findings show that all muscle injury markers were comparable at baseline and increased following exercise, with no differences in the magnitude of exercise-induced elevations among groups.
 
Muscle pain scores were higher at baseline in symptomatic statin users, but they increased similarly in all groups following exercise, indicated that statin use and the presence of statin-associated muscle symptoms ‘does not exacerbate exercise-induced muscle injury after moderate exercise’.
 
Lead author Neeltje Allard, a researcher at the Department of Integrative Physiology at Radboud University Medical Center in the Netherlands, said the results are reassuring for patients who experience statin-related muscle pain or fatigue but would benefit from exercise.
 
‘These results demonstrate that prolonged moderate-intensity exercise is safe for statin users and can be performed by statin users to maintain a physically active lifestyle and to derive its cardiovascular health benefits,’ she said.
 
As statins can lower CoQ10 levels, which can predispose people to muscle injury, the researchers also examined the association between leukocyte CoQ10 levels on muscle injury and muscle complaints. However, they did not find a correlation.
 
CVD occurs in 18% of Australians and physical activity is among the most important behavioural and physiological risk factors.
 
Dr Zhen Zhou is a post-doctoral research fellow at the University of Tasmania’s Menzies Institute for Medical Research, with an interest in the effect of statin therapy in older adults for primary prevention of CVD.
 
She told newsGP the study findings are reassuring for GPs.
 
‘Muscle problems are the most commonly reported adverse events of statins,’ Dr Zhou said.
 
‘Individuals who engage in regular exercise are prone to muscle injury, [and] thus may be more susceptible and vulnerable to these side effects.
 
‘This finding provides reassurance to GPs who are hesitant to prescribe statins due to concerns about statin safety.’
 
However, Dr Zhou did note the study’s small sample size and short follow-up period, saying that a firm conclusion on the safety of statin use in people who engage in regular exercise ‘cannot be drawn’.
 
‘More investigations are needed to confirm their results,’ she said.
 
‘Also, among statin users who reported muscle problems, it is unclear whether these symptoms were caused by statin medication or other reasons, and how severe these symptoms were.’
 
The research also excluded people with diabetes, hypo- or hyperthyroidism, known hereditary skeletal muscle defects, and other diseases known to cause muscle symptoms, as well as those using CoQ10 supplementation.
 
And despite the study’s positive findings, Dr Zhou said it ‘remains crucial’ for GPs to pay close attention to any potential statin-related side effects.
 
‘Particularly muscle problems in individuals who are at higher risk, for example patients with sarcopenia [or] musculoskeletal diseases,’ she said.
 
The RACGP recommends that adults have their blood lipids assessed every five years starting at 45 years of age, and that patients prescribed medications for high blood pressure or cholesterol be regularly reviewed to assess the ongoing benefits and risks.
 
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cardiovascular disease cholesterol CVD heart health LDL moderate exercise physical activity statins