On Wednesdays, I try to write on a topic of exercise and health.
If you exercise but still have high cholesterol or other risks for heart disease, you may be interested in a new study from my old medical school proving ground–Hartford Hospital.
Muscular complaints related to statin drugs are a common occurrence. I see it often. The incidence of muscle-related issues (pain, weakness, or enzyme abnormalities) range from 1% to 25%. Estimates from clinical trials of statin drugs likely underestimate the real world incidence of the problem. Observational trials, which look back at general populations, mirror what most doctors will tell you: that the incidence of muscle symptoms on these drugs approaches 10% or higher. It’s a vexing problem because statin drugs offer selected patients significant protection from cardiovascular events.
For exercisers, especially competitive athletes, muscle function is something that we hold dear. We don’t want a heart attack or stroke; we’d take a drug that would lower that risk; but we cannot have—it would just be too bitter a pill—a treatment that hurts our precious muscles. For cyclists and runners alike, “bad legs” is a never event—always to be avoided.
The STOMP study:
Reed Miller has a nice recap on theHeart.org. Here’s my short summary:
Researchers randomized 468 patients to either a statin drug (atorvastatin, Lipitor 80mg daily) or a placebo. The study was double blinded. Neither the investigators nor the patients knew the treatment assignment. Patients were followed and tested over a 6-month period. This simple but elegant experiment allowed the researchers to answer their main question (hypothesis): Do statin drugs reduce muscular strength or endurance?
- Patients on atorvastatin exhibited a small rise in CK (muscle enzyme) levels, although no subject reached the definition of muscle inflammation (myositis).
- More patients on the statin drug than placebo (40 v 29) had CK levels out of the normal range.
- Muscle pain or myalgia (strictly defined) was noted in 19 subjects on statin v 10 on placebo.
- Statin-induced muscle complaints involved the big muscles of the legs, whereas placebo-induced complaints scattered throughout the body.
- Muscular strength and aerobic performance were similar in both groups.
The findings of the STOMP trial provide a degree of reassurance to patients and doctors. Although high-dose statin therapy may increase the incidence of muscle complaints or cause slight rises in muscle enzymes, these drugs do not reduce muscle strength or endurance.
If confirmed in other studies, this is big news for athletes.
I found STOMP worth mentioning because I’ve always wondered whether these (potentially) life-extending drugs force an exerciser to make a choice. Does one have to trade watts, MPH, min/mile, bench press (or whatever your measure) for cardiac protection?
Of course, as an athlete, I favor such favorable results. It’s what I wanted to hear. I didn’t want to have to tell exercisers that a statin drug will make them slower or weaker.
Liking a study’s results a lot should trigger an internal warning sensation. It should cause you to talk to yourself. Am I drawn to the findings because they are sound scientifically or do they support my pre-conceived notion?
So let’s be careful not to overreach. STOMP is a small single center study done on low-risk young patients. It has significant limitations. These findings may not generalize to older and sicker patients. (Remember: it would be unethical to do such a study in older high-risk patients–as statins have proven benefit in this group.)
The major limitation of the study, however, was its short duration—only six months. Many patients prescribed statin drugs will be on them longer than six months. Will these muscle-neutral findings hold up over years or decades? That question can only be answered with longer follow-up.
And this final caveat:
Please don’t misinterpret my commentary. I am not citing this study as proof positive that statin drugs are safe. Like all medicines, statins are potent chemicals that have real effects on the human body. They have risks, benefits and alternatives. I’m not delving into whether you should take a statin drug. That should be a shared decision between patient and doctor.
Other good references:
Nice review article on Statin myopathy: A common dilemma not reflected in clinical trial