Stay Fit and Use Statins Cautiously

Doctors commonly prescribe statins to reduce the risk of cardiovascular disease in susceptible patients. Statins are very beneficial for those with proven heart disease—they reduce cholesterol levels and reduce risk of heart attack and death.

However, viewing statins as a ‘quick fix’ for heart disease by treating high cholesterol levels is wrong. We have drugs, like statins, that lower cholesterol effectively, so we often forget that there are other tools to reduce risk. It’s one of many examples of doctors and patients focussing on a blood test to the point where the bigger picture is lost.

The correlation between cholesterol levels and the risk of heart disease has led to a ‘one-size fits all’ approach—treating a number without regard to other aspects of health. But we are not numbers. We are complex human organisms.

Let’s have a peek underneath this ‘one size fits all’ approach adopted by many healthcare professionals.

The Limitation of Statins

Research on statins’ ability to prevent heart disease before it becomes manifest tells us that:
■ Statins are not clearly beneficial for primary prevention in women.
■ Elite athletes, those with the highest fitness levels, do not tolerate statins well.

There is a growing body of evidence that statins may increase susceptibility to muscle damage during exercise. One recent study divided 14,000 patients into 2 equal groups: those who had used statins for at least 90 days and non-users (those who had never taken a statin). The rates of complaints in the two groups were then compared.

The statin users had a 20% higher risk of joint aches, dislocations, sprains, strains and muscular pains. In my own practice, I have found that vague aches and pains associated with the use of statins are indeed quite common.

More troubling is a study in which researchers investigated whether statin use changes the body’s ability to improve fitness through exercise training. Sedentary overweight adults were randomly assigned to receive either 12 weeks of aerobic exercise training or exercise in combination with a statin called simvastatin.

The aerobic exercise-only group increased their cardiorespiratory fitness by 10% . The group that took the statin as well as engaged in the same exercise regimen increased their cardiorespiratory fitness by considerably less—1.5%. In other words, the addition of a statin prevented improvement in fitness.

The Case for Fitness

Important studies have shown that increases in fitness are associated with reductions in mortality independent of lowering of cholesterol levels. Moreover, as fitness increases, lowering cholesterol becomes less important as a preventive measure, at least in men.

To summarise, statin-induced reductions in cholesterol, especially the ‘bad’ LDL cholesterol are, indeed associated with reductions in risk of cardiovascular events and mortality. Exercise also prevents heart disease. What we don’t know yet— because we don’t yet have any large randomised trials—is how much risk is reduced with exercise and statins together or separately.

Lesson for You

Stay fit no matter what. Take a statin if you have proven heart disease, if you can do so without side effects. Don’t despair if you cannot tolerate the drug without side effects, though—just stay active and exercise.
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