Statins and Exercise
Sep 16, 2013
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
I know it might surprise you, but Im not Indiana Jones. My bald head does look good in a fedora, and I used to be able to crack a whip, but Im not the fictional archeologist. However, we do share a distain for snakes. I dont think I hate them as much as he does, but I dont love them. So in late summer when a garter snake decided to follow a patient into the Winnipegosis Clinic Pharmacy, it created a bit of excitement. I got elected snake catcher. The snake was tiny and my rational mind knew it couldnt hurt me. But my rational mind wasnt in control. I needed another way to catch the snake before it got into the cold air return vent. I needed the right tool for my snake problem. Just like someone who has high cholesterol. They need the right tool for their cholesterol problem.
What is cholesterol and why do you need to bring high cholesterol down? Cholesterol is a naturally occurring substance in the body that is essential for life. If you had no cholesterol in you, you would die. Cholesterol helps form bile acids in your digestive system, hormones in your endocrine system and important components of every cell membrane in your body. Although cholesterol is essential for life, you dont have to eat any. Your liver can make all the cholesterol you need.
If cholesterol is essential for life, why does your doctor care if your cholesterol is high? Your doctor cares about blood cholesterol levels because if they are too high for too long you have greater chance of getting a heart attack or a stroke. Heart attacks and strokes account for about one third of all the deaths in Canada. That is more than any other disease.
If you have high cholesterol, your doctor will probably first talk about diet and exercise. Diet and exercise are important tools to prevent heart attacks and strokes. Your doctor will probably also talk about cholesterol lowering medications. The most common tool in the cholesterol lowering medication tool box are called the statins. The statins reduce how much cholesterol the liver makes. We have lots of studies that show if we reduce someones cholesterol with statins we can reduce the chances of heart attacks and strokes by 25% to 35% with five years use
So we know that the tool called the statins are good for your heart, if you have high cholesterol. In fact statins are the most prescribed class of medications worldwide. These tools have been proven to reduce how often people are disabled and killed by heart disease. We know exercise is a good tool for your heart. A study of over 10,000 veterans published in the February 2013 Lancet by Kokkinos et al showed that those veterans with high cholesterol who exercised died less often than those who didnt. But there was one study this summer using the heart tool the statins and the heart tool exercise together that caused some concern.
In the July 2013 JAMA Internal Medicine, Mansi et al published an observational study of about 46,000 people in the military. This wasnt a double blind, placebo controlled trial where half the people were given a drug and half were given a sugar pill. The reseachers just looked back at insurance forms for one year. They didnt ever see or talk to the patients. They looked to see if the people who made insurance claims for statins also made insurance claims for muscle injuries. They found more people who took statins had muscle injuries than those who didnt. So the obvious question people have been asking me is if I am on a statin, should I avoid exercise?
The answer is no. Please continue to use the heart tool exercise even if you are using the heart tool called the statins. The JAMA Internal Medicine study was interesting. However it was not definitive that people on statins get muscle injury more often than people who are not on statins. There are even studies that show people on statins have no decrease in muscle strength or endurance as compared to placebo. So whether or not the heart tool the statins effect the heart tool of exercise is still up in the air.
It is still okay to use the heart tool of exercise even if you are on a statin medication. There are some things that can be done to help minimize the chance of having muscle pain or injury if you are on a statin, though. As with any new exercise regime, start very slowly and increase gradually. Your goal should be to exercise 30 minutes per day 5-7 days a weeks, but it is okay if it takes you several weeks to a couple of months to get to that goal. When you increase your exercise, consider exercising longer rather than harder to minimize the chance of muscle injury. Also consider varying the exercise to avoid muscle overuse. If a person does get muscle pain when they are on a statin, there are a number of things we can do. We can decrease the dose or switch the statin. I have recommended taking Coenzyme Q10 to prevent muscle pain from statins. There isnt good evidence to support that Co Q10 reduces statin muscle pain, but it shouldnt cause any harm to try it out either.
It is important to find the right tool for the job. Both exercise and statins are good tools to prevent heart disease. For my Winnipegosis snake problem, I choose a 26.5 folding reacher. It is a tool that is usually used by people who have trouble bending over to pick things up off the floor. It turns out to be wonderful tool for catching snakes if you are too squeamish to touch them. But the reacher did help me prevent the snake from getting into the pharmacys duct work.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
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