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Heart Attack Prevention: Statins and Exercise

If you have high cholesterol, then your doctor has surely talked to you about eating right and exercising. You may also be on a statin drug like Lipitor® (atorvastatin), Zocor® (simvastatin) or Crestor® (rosuvastatin).

So what to make of research suggesting that statins may interfere with our ability to get the maximum benefit from heart-healthy exercise? “Statins are among the most widely prescribed drugs in the world, and more and more patients are asking about this study,” says preventive medicine specialist Roxanne B. Sukol, MD, of Cleveland Clinic’s Executive Health Program. 

Michael Rocco, MD, of Cleveland Clinic’s Department of Cardiovascular Medicine, notes that “muscle pain and weakness are a real issue for up to 8 to 10 percent of patients taking statins, and may limit their ability to continue on statins or to exercise. But it’s important to put the new research into perspective.”

How statins help

Statins reduce cholesterol levels to prevent fatty buildup in arteries supplying the heart. This is critical for people at moderate to high risk of heart disease. Statins reduce their risk of heart attack, stroke and death, and the likelihood that they’ll need angioplasty or bypass surgery in the future. Multiple statin trials have shown that people without evident cardiovascular disease but who are at risk of heart disease benefit from statin therapy too.

“The benefits of statin therapy still far outweigh the risks in appropriately selected patients,” says Dr. Rocco. “But all medications and treatments come at a potential price.”

Studying statins and exercise training

A study published in the May 2013 Journal of the American College of Cardiology looked at the problem of muscle symptoms and statins in detail.

University of Missouri researchers followed 37 overweight, sedentary participants with two of five risk factors for metabolic syndrome (a condition that  increases the risk for diabetes and adverse cardiovascular events).

None of the people in the study had ever taken statins. All began a three-month exercise training program, working up to 45 minutes of treadmill walking or jogging for five days a week. Half received simvastatin, and half did not.

LDL (bad) cholesterol levels fell 40 percent in the statin group and increased slightly in the non-statin group. Yet cardiovascular fitness increased 1.5 percent in the statin group vs. more than 10 percent in the non-statin group. “Muscle biopsies showed that mitochondrial enzyme levels (expected to rise in the cell during exercise) rose 13 percent in the non-statin group but fell 4.5 percent in the statin group despite the increase in exercise,” notes Dr. Sukol.

What the study means for patients

“This study is useful because it adds to our emerging knowledge about the relationship between statins and muscle symptoms,”  says Dr. Rocco. “But it’s not necessarily a reason to deny statins to those who might benefit from them. Working with each individual patient to find an appropriate medication regimen that does not cause limiting symptoms is important.”

Says Dr. Sukol, “If you are on a statin and you develop muscle cramps or pain that you believe may be associated with the statin, call your doctor’s office promptly.” You may need further testing. Your doctor can also outline statin therapy’s risks and benefits for you.  

If your doctor feels you may still benefit from statin therapy, a change in regimen may help. People who can’t tolerate one statin often do well on another, says Dr. Rocco.They often start with a lower dose, taken less frequently, and slowly build up to the required dose or take the statin with coenzyme Q10.

“We try multiple statins before calling it quits,” he explains. “Up to two-thirds of the patients referred to us for statin intolerance due to muscle issues are able to get onto some type of statin regimen with acceptable side effects.”

For patients who aren’t able to tolerate any type of statin, it’s possible to try other drugs to lower cholesterol, adds Dr. Rocco. In the meantime,Whether you’re on a statin or not, leading a healthy lifestyle — including an appropriate diet and exercise program — remains an integral part of reducing cardiovascular risk,” he says.

Tips for making healthy changes

If you are overweight and sedentary and do not yet have problems with cholesterol, making lifestyle changes now can help you lower your risk of heart disease later.

Start with regular physical activity. You don’t need a formal exercise program. You don’t have to train for the Olympics. You just need to move,” says Dr. Sukol. “Nothing will protect you from a heart attack more than being in good shape.”

In addition, you’ll want to eat a healthy diet, get adequate rest and relaxation, and avoid smoking. The goal, she says, is to strive for normal numbers: weight, blood pressure, blood sugar and cholesterol.

Taken together, these steps can help you avoid heart disease and other chronic illnesses.

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