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Statin Drugs and Exercise

The evidence is overwhelming that statin drugs do help to lower cholesterol and to reduce risk for heart attacks. However, a new study confirms that statins interfere with the ability to exercise and to compete in sports, even in patients who report no symptoms (J Clin Endocrinol Metab, 2018;103(1):75-84). Statins cause muscle damage and reduced ability to exercise by decreasing the number and function of muscle mitochondria, the energy sources for muscles during exercise. This study agrees with others showing that statins interfere with a person's ability to compete in sports (J Am Coll Cardiol, 2013;62(8):709–714). Up to 30 percent of patients who take statins suffer muscle pain or torn muscles (Eur Heart J, 2015;36(17):1012–1022), and people who exercise are far more likely to complain of muscle pain, muscle injuries and fatigue while taking statins (Br J Clin Pharmacol, 2004;57(4):525–528).

The Study
Twenty people who had taken statin drugs for many years were included in this new study. Ten suffered muscle pain and undue fatigue during exercise, while ten reported no symptoms during exercise or at rest. The authors used the following tests:
• maximal incremental cycling test,
• involuntary electrically stimulated isometric quadriceps muscle contractions, and
• biopsy of the vastus lateralis muscle.

Both groups had the same maximal endurance and maximal ability to take in air and use oxygen. However, compared to people who had never taken statin drugs, those who took statins (whether they reported symptoms or not) had:
• decreased anaerobic threshold (muscle pain and burning during exercise because of the accumulation of lactic acid in muscles from lack of oxygen),
• prolonged muscle relaxation time (delayed recovery from exercise),
• decreased rate of maximal force rise during exercise (loss of strength),
• reduced numbers of mitochondria in their muscles, and
• in the symptomatic statin takers only, reduced activity of mitochondria (decreased ability for muscles to use oxygen during exercise).

This shows that, compared to people who never took statins, the people who took long-term statins tired earlier during maximal exercise because they had lost some of their ability to take in and use oxygen, since their mitochondria could not use oxygen as efficiently to turn food into energy to power their muscles. This suggests that statins interfere with a person's maximum ability to exercise long and hard, even in people who have no complaints.

My Recommendations
If your bad LDL cholesterol is above 100 or you have other factors that increase risk for a heart attack, most guidelines recommend that you take statin drugs to help protect you from suffering a heart attack. However, statin drugs come at a price. They can cause muscle pain and damage and can interfere with your ability to exercise. If you are a competitive athlete, they can interfere with your ability to compete at your best.

Studies show that strict lifestyle changes can be as effective as statins in lowering high blood levels of the bad LDL cholesterol and reducing your risk for a heart attack. I recommend that everyone, whether they take statins or not, should:
• follow a diet that is rich in vegetables, fruits, whole (unground) grains, beans, nuts and other seeds
• restrict or avoid sugared drinks and sugar-added foods, mammal meat, processed meat, fried foods, and refined grains (foods made from flour or white rice)
• avoid being overweight
• try to exercise every day
• keep blood levels of hydroxy vitamin D above 20 ng/dl
• avoid smoke, alcohol and recreational drugs

March 16th, 2018
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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