Heart Attack Prevention: Statins and Exercise

Putting new research into perspective

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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 the Department of Cardiovascular Medicine at Cleveland Clinic, 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.”

“The benefits of statin therapy still far outweigh the risks in appropriately selected patients … People who can’t tolerate one statin often do well on another.”

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.

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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.”

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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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  • http://www.facebook.com/profile.php?id=100001010672086 George MacDonald

    First: They need to separate “muscle Pain” from “muscle weakness”. They are separate — and combining them is misleading.

    Second: Statins are known to reduce levels of CoQ10 via the same process that they reduce LDL. That is part of their nature and cannot be separated. If you take a statin you reduce both of them.

    Third: Current guidelines say that statins are not causing harm until myopathy develops. A diagnosis of myopathy requires both myalgia as well as increased CK levels… So, muscle weakness is basically ignored.

    Fourth: CoQ10 that is reduced by statins is required for muscles to work effectively. That is: muscles use ATP produced by the body for their energy. Without CoQ10 they body cannot produce ATP — so you get reduced muscle strength.

    Medical science continues to turn a blind eye to the whole cause and effect thing of the muscle weakness that statins cause.

    Fifth: Seniors are the ones most likely to be on statins; They are also the ones to suffer falls created by muscle weakness as well as general debility.


  • Gregoochy

    The best change anyone can make is to change to a Vegetarian or Vegan lifestyle similar to the one supported by Dr Caldwell Esselstyn in his book Prevent and Reverse Heart Disease. The changes are quick and profound. My cholesterol dropped 65 points from 225 to 160 after just one month on a Vegan diet, something I could not do with exercise alone. I also lost 30 lbs and many other ailments, aches and pains. Watch Dr. Esselstyn’s forks over knives videos on you tube.

    • GeorgeBMac

      Yes, but you — and Dr Esselstyn — both imply (but do not actually say) it is an ‘either / or’ situation. I.e., that his diet program is sufficient.
      I agree that it is far better than no diet program.
      But also: an exercise program is also better than no exercise program
      And: the BEST is BOTH

      In addition, a serious exercise program (45 – 90 minutes a day, 5 days a week where the heart rate is elevated to the point of making talking difficult), provides benefits that diet alone cannot provide. It tones your whole system, builds cardiac reserve, reduces BMI, improves both lipid profiles and endothelial function.

      .. You need both to be healthy…
      ….. And, together, if you follow the guidelines set by Dr Esselstyn, they provide benefits that statins cannot.. (But most people just give it the half hearted efforts suggested by the cardiologists and then say: “It didn’t work for me”.)

  • http://www.onlineusadoctors.com/ Terrie Dawson

    A healthy heart is a need of everyone but
    today nowadays Heart Attack become very common heart disease. Coronary
    atherosclerosis is the hardening and narrowing of the arteries that supply
    blood to the heart muscle. Coronary atherosclerosis is the major cause of heart
    attacks. We can make our own efforts to prevent from heart attack by lowering
    high blood pressure, controlling diabetes, stop cigarette smoking and as on
    described in the article. Great article Thanks to share.

  • http://www.corindus.com/ Corindus Vascular Robotics

    “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.”

    Just because a problem hasn’t presented itself doesn’t mean that it won’t happen later down the road. Taking preventative steps now can help reduce the risk of developing heart disease.

    • The_Beating_Edge_Team

      True! Thanks for your comment.