Moderate exercise may be safe for patients with statin-related muscle pain
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Key takeaways:
- Statin use was not associated with any greater change in exercise-related muscle injury vs. nonuse.
- The findings were consistent regardless of baseline statin-related muscle pain or lack thereof.
In a short-term study, researchers found no effect of statin therapy on self-reported muscle injury or symptoms after moderate exercise, regardless of whether patients were symptomatic at baseline.
After exercise, markers of muscle injury increased similarly among symptomatic and asymptomatic participants on statin therapy as well as within a control group of participants not taking any statins, according to data published in the Journal of the American College of Cardiology.
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“The mechanisms underlying [statin-associated muscle symptoms] and statin-induced muscle injury are poorly understood. ... Exercise, especially high-intensity exercise, increases energy demands and could produce muscle fatigue and damage if energy production is compromised. This mechanism is supported by the observation that mitochondrial dysfunction is more pronounced in patients with statin-associated muscle symptoms,” Neeltje A.E. Allard, MD, of the Radboud Institute for Health Sciences and the department of physiology at Radboud University Medical Center in Nijmegen, the Netherlands, and colleagues wrote. “We sought to compare the impact of moderate-intensity exercise on muscle injury between symptomatic and asymptomatic statin users and nonuser control subjects.”
Allard and colleagues recruited 69 statin users (35 with muscle symptoms; mean age, 62 years; 34 without symptoms; mean age, 68 years) and 31 nonusers (mean age, 68 years) who participated in the 102nd Four Day Marches Nijmegen in which participants walked 30 km, 40 km or 50 km per day at a self-selected pace for 4 consecutive days. For this study, participants were recruited via the Nijmegen Exercise Study database and social media.
Statin users were considered symptomatic based on the presence, localization and onset of muscle cramps, pain and/or weakness using the statin myalgia clinical index score, according to the study.
Markers of muscle injury including lactate dehydrogenase, creatine kinase, myoglobin, cardiac troponin I and N-terminal pro-B-type natriuretic peptide as well as muscle performance and self-reported muscle symptom scores were measured at baseline and after exercise. In addition, leukocyte coenzyme Q10 (CoQ10)was measured at baseline.
Exercise and statin-related muscle symptoms
All markers of muscle injury were comparable between the two groups at baseline (P > .05).
All markers of muscle injury increased after exercise (P < .001), with no significant differences observed in the magnitude of elevations among groups (P > .05), according to the study.
Reported muscle symptoms were higher among those with statin-associated muscle symptoms compared with asymptomatic and nonuser participants (P < .001), but muscle symptoms increased similarly for all groups when measured after exercise (P < .001).
In addition, muscle relaxation time after exercise increased more among participants with statin-associated muscle symptoms compared with controls (P = .035).
Moreover, leukocyte CoQ10 levels did not differ among symptomatic (2.3 nmol/U), asymptomatic (2.1 nmol/U) and control group participants (2.1 nmol/U; P = .2) and was not associated with markers of muscle injury, fatigue resistance or reported muscle symptoms, according to the study.
“This study demonstrated that habitually active statin users can engage in prolonged moderate-intensity exercise without exacerbating skeletal muscle injury and reinforces the recommendation to combine statin therapy with a physically active lifestyle,” the researchers wrote. “This is an important strategy in the prevention of cardiovascular diseases.”
Importance of exercise in patients on statins
In a related editorial, Robert S. Rosenson, MD, director of metabolism and lipids for the Mount Sinai Health System and professor of medicine in cardiology at the Icahn School of Medicine at Mount Sinai, discussed the importance of exercise for patients eligible for statin therapy.
“Exercise is an essential component of restoring fitness for maintaining health and fitness in all patients at increased risk for an atherosclerotic cardiovascular disease event, particularly those with a disabling event, such as myocardial infarction, and treatment of major cardiovascular risk factors, such as hypertension, prediabetes, or diabetes and dyslipidemia,” Rosenson wrote. “Many patients who develop statin-associated muscle symptoms may engage in a moderately intensive walking program without concern for worsened muscle biomarkers or performance. Although exercise was accompanied by more fatigue in symptomatic vs. asymptomatic statin users in this short-term study, it remains uncertain from this study whether sustained exercise in statin-associated muscle symptoms patients will effectuate improved metabolic biomarkers or exercise capacity in the long term.”
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