Statins do not worsen muscle pain or injury after moderate-intensity exercise

Statins are generally well-tolerated, but can cause statin-associated muscle symptoms in some patients. Strenuous physical activity may exacerbate statin-associated muscle symptoms, resulting in decreased physical activity or statin nonadherence. Less is known about the impact of moderate exercise on statin-associated muscle symptoms.1 To examine this issue, researchers in the Netherlands compared the impact of prolonged moderate-intensity exercise on muscle injury between symptomatic and asymptomatic chronic statin users and control subjects who were not using statins. The researchers also examined the association between coenzyme Q10 (CoQ10) levels in leukocytes and exercise-induced muscle injury and reported muscle symptoms, since statins may lower CoQ10 levels and reduced levels can predispose people to muscle injury.1,2 In the Netherlands study, symptomatic statin users (n=35; age 62 ± 7 years; 80% men) and asymptomatic statin users (n=34; age 66 ± 7 years; 82% men) and control subjects (n=31; age 66 ± 5 years; 68% men) walked 30, 40 or 50 km/day for four consecutive days. The investigators assessed muscle injury markers (lactate dehydrogenase, creatine kinase, myoglobin, cardiac troponin I, N-terminal pro-brain natriuretic peptide), muscle performance, and reported muscle symptoms at baseline and after exercise. Leukocyte CoQ10 was measured at baseline.1 Statin users were considered symptomatic or asymptomatic based on the presence, localization and onset of muscle cramps, pain and/or weakness using the statin myalgia clinical index score. Patients were excluded from the study if they had diabetes mellitus, hypothyroidism, hyperthyroidism, known hereditary skeletal muscle defects or other diseases known to cause muscle symptoms (e.g., Parkinson or rheumatic diseases), or if they were using CoQ10 supplements.1 Results showed the following: All muscle injury markers were comparable at baseline and increased following exercise; no differences were seen in the magnitude of exercise-induced elevations among the three groups. Muscle pain scores were higher at baseline in symptomatic statin users and increased similarly following exercise in all groups. Fatigue scores were higher in symptomatic statin users compared with asymptomatic statin users and control subjects at baseline, and increased similarly with exercise in all groups. CoQ10 levels did not differ among symptomatic statin users, asymptomatic statin users and control subjects, and did not relate to muscle injury markers, fatigue resistance or reported muscle symptoms.1 The authors conclude that statin therapy does not augment exercise-induced muscle injury associated with prolonged moderate-intensity exercise. Muscle pain and fatigue scores increased similarly in all groups with exercise and were not worsened by statins. The results of this study suggest that habitually-active statin users can engage in prolonged moderate-intensity exercise without exacerbating skeletal muscle injury.1,2 In a press release, Neeltje Allard, MD, lead author of the study and researcher at the Department of Integrative Physiology, Radboud University Medical Center in Nijmegen, Netherlands commented that “These results demonstrate that prolonged moderate-intensity exercise is safe for statin users and can be performed by statin users to maintain a physically active lifestyle and to derive its cardiovascular health benefits.”2 In an accompanying editorial, Robert Rosenson, MD, Director of Metabolism and Lipids for the Mount Sinai Health System in New York, indicated that patients experiencing statin-associated muscle symptoms will often avoid exercise because of muscle pain and weakness and concerns about making the pain worse.3 However, based on these study results, he commented that “Many patients who develop statin associated muscle symptoms may engage in a moderately intensive walking program without concern for worsened muscle biomarkers or performance.”2 References 1. Allard NAE, Janssen L, Lagerwaard B, et al. Prolonged moderate-intensity exercise does not increase muscle injury markers in symptomatic or asymptomatic statin users. J Am Coll Cardiol 2023;81:1353-64. 2. American College of Cardiology. Moderate exercise safe for people with muscle pain from statins. Statins do not increase muscle injury after prolonged walking, important for heart health in statin users. News release April 3, 2023. (accessed April 17, 2023). 3. Rosenson RS. The importance of exercise in cardiometabolic health in patients reporting statin-associated muscle symptoms (editorial). J Am Coll Cardiol 2023;81:1365-7.

Statins do not worsen muscle pain or injury after moderate-intensity exercise

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