NIJMEGEN, Netherlands — Researchers working with the American College of Cardiology say statin therapy does not exacerbate muscle injury, pain, or fatigue while engaging in light exercises such as walking. The team adds that this work should reassure anyone dealing with muscle pain or fatigue from statins looking to stay active, keep cholesterol levels low, and their hearts healthy.
Statins have been the gold standard treatment when it comes to lowering LDL (bad) cholesterol and preventing cardiovascular disease (CVD) events before they occur. However, while most patients generally tolerate taking statins without side-effects, they can cause muscle pain and weakness in certain individuals.
Intense workouts may lead to muscle damage while on statins
Physical activity, meanwhile, is a cornerstone of CVD prevention, especially when combined with statins. Some studies, however, indicate vigorous exercise can increase muscle damage in some statin users, subsequently leading to decreased exercise or patients stopping their medication. There has been less research, though, regarding the impact of moderate exercise.
So, the research team decided to compare the impact of moderate-intensity exercise on muscle injury in symptomatic and asymptomatic statin users, in addition to non-statin using controls. Study authors determined symptomatic versus asymptomatic by the presence, localization, and onset of muscle cramps, pain, and/or weakness using the statin myalgia clinical index score. Since statins display an ability to lower CoQ10 levels and reduced levels can predispose people to muscle injury, study authors were also sure to examine the association between leukocyte CoQ10 levels on muscle injury and muscle complaints.
All participants walked 18.6, 24.8, or 31 miles, respectively, per day at a self-selected pace for a total of four consecutive days. Each person designated as statin users had been on the medication for at least three months. The research team excluded anyone with diabetes, hypo or hyperthyroidism, known hereditary skeletal muscle defects, any other diseases known to cause muscle symptoms, or those using CoQ10 supplementation.
Sticking to long walks is a safe way to stay in shape
At baseline, the team did not note any differences in reference to body mass index, waist circumference, physical activity levels, or vitamin D3 levels among the three groups. Studies have connected low vitamin D3 levels with statin-induced myopathy, and thus may be a risk-factor for statin-associated muscle symptoms. Ultimately, researchers found that the statins did not exacerbate muscle injury or muscle symptoms after bouts of moderate-intensity exercise.
“Even though muscle pain and fatigue scores were higher in symptomatic statin users at baseline, the increase in muscle symptoms after exercise was similar among the groups,” says Neeltje Allard, MD, first author of the study and a researcher from the Department of Integrative Physiology at Radboud University Medical Center, in a media release. “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.”
Notably, results did not show a correlation between leukocyte CoQ10 levels and muscle injury markers at baseline or after exercise, nor was there a correlation connecting CoQ10 levels and muscle fatigue resistance or muscle pain scores.
In an accompanying editorial comment, Robert Rosenson, MD, Director of Metabolism and Lipids for the Mount Sinai Health System in New York, adds that many patients experiencing statin associated muscle symptoms will avoid exercise due to concerns over making the pain worse. Exercise, however, is essential for restoring and maintaining fitness – especially among those at an increased risk of cardiovascular disease.
“Based on the study, many patients who develop statin associated muscle symptoms may engage in a moderately intensive walking program without concern for worsened muscle biomarkers or performance,” he concludes.
The study is published in the Journal of the American College of Cardiology.