Exercise-induced Myalgia may Limit the Cardiovascular Benefits of Statins
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REVIEW ARTICLE
Exercise-induced Myalgia may Limit the Cardiovascular Benefits of Statins Lionel H. Opie
# Springer Science+Business Media New York 2013
Abstract The positive health benefits of statins extend beyond the cardiovascular and include increased flow mediated dilation, decreased atrial fibrillation, modest antihypertensive effects and reduced risks of malignancies. Prominent among the statin side-effects are myalgia and muscular weakness, which may be associated with a rise in circulating creatine kinase values. In increasing severity and decreasing incidence, the statin-induced muscle related conditions are myalgia, myopathy with elevated creatine kinase (CK) levels with or without symptoms, and rhabdomyolysis. Statin use may increase CK levels without decreasing average muscle strength or exercise performance. In one large study, only about 2 % had myalgia that could be attributed to statin use. A novel current hypothesis is that statins optimize cardiac mitochondrial function but impair the vulnerable skeletal muscle by inducing different levels of reactive oxygen species (ROS) in these two sites. In an important observational study, both statins and exercise reduced the adverse outcomes of cardiovascular disease, and the effects were additive. The major unresolved problem is that either can cause muscular symptoms with elevation of blood creatine kinase levels. There is, as yet, no clearly defined outcomes based policy to deal with such symptoms from use of either statins or exercise or both. A reasonable practical approach is to assess the creatine kinase levels, and if elevated to reduce the statin dose or the intensity of exercise.
Keywords Statins . Exercise . Muscles . Mitochondria . Myalgia
L. H. Opie (*) Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town Medical School, Anzio Road, Observatory, Cape Town 7925, South Africa e-mail: [email protected]
Introduction Statins are increasingly seen to have positive health benefits beyond the robust cardiovascular benefits that follow from lipid-reduction [1]. Among the beneficial non-lipid pleotropic effects are: increased flow mediated vascular dilation [2], a decreased incidence of atrial fibrillation [3], modest antihypertensive effects [4], and in an observational study reduced risk of malignancies in a variety of organ sites [5]. Yet there is also increasing focus on statin side-effects, especially in those with the common complaints of pains and weakness in the muscles of the legs [6], and also with those undertaking intense sports [7, 8]. This attention-catching problem raises several practical and mechanistic issues. The present pragmatic approach to the combined use of statins and exercise to improve cardiovascular outcomes, also runs the risk of increasing muscular pains (Fig. 1).
What is the Significance of Muscle Pains in Those Taking Statins? Risks for myopathy with statin therapy were first considered in high-risk patients, in whom Ballantyne et al. described muscle related c
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