Key result
Statin use does not exacerbate exercise-induced muscle injury after prolonged exercise.
Why the study?
Statin use may exacerbate exercise-induced skeletal muscle injury due to reduced coenzyme Q10 levels causing mitochondrial dysfunction, but the effect of prolonged moderate-intensity exercise on muscle injury markers in statin users with and without symptoms was unclear.
Does statin use exacerbate exercise-induced muscle injury after prolonged moderate-intensity exercise in symptomatic or asymptomatic users?
Observational (n=100)
No
Does statin use exacerbate exercise-induced muscle injury after prolonged moderate-intensity exercise in symptomatic or asymptomatic users?
p-value: p=>0.05
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“It is really important to combine physical activity with statin therapy in patients at risk of cardiovascular disease. Some patients might be a little hesitant to engage in exercise because they fear their muscle symptoms will get worse, but this study is quite reassuring. They can safely engage in moderate-intensity exercise. It's safe in terms of muscle injury, but also in terms of muscle performance.”
“In summary, many patients who develop SAMS may engage in a moderately intensive walking program without concern for worsened muscle biomarkers or performance. Although exercise was accompanied by more fatigue in symptomatic vs asymptomatic statin users in this short-term study, it remains uncertain from this study whether sustained exercise in SAMS patients will effectuate improved metabolic biomarkers or exercise capacity in the long term.”
“Even though muscle pain and fatigue scores were higher in symptomatic statin users at baseline, the increase in muscle symptoms after exercise was similar among the groups. 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.”
Prolonged moderate-intensity exercise does not disproportionately increase muscle injury markers in statin users, suggesting it is safe for maintaining physical activity regardless of statin-associated muscle symptoms.
BACKGROUND Statin use may exacerbate exercise-induced skeletal muscle injury caused by reduced coenzyme Q10 (CoQ10) levels, which are postulated to produce mitochondrial dysfunction. OBJECTIVES We determined the effect of prolonged moderate-intensity exercise on markers of muscle injury in statin users with and without statin-associated muscle symptoms. We also examined the association between leukocyte CoQ10 levels and muscle markers, muscle performance, and reported muscle symptoms. METHODS Symptomatic (n = 35; age 62 ± 7 years) and asymptomatic statin users (n = 34; age 66 ± 7 years) and control subjects (n = 31; age 66 ± 5 years) walked 30, 40, or 50 km/d for 4 consecutive days. Muscle injury markers (lactate dehydrogenase, creatine kinase, myoglobin, cardiac troponin I, and N-terminal pro-brain natriuretic peptide), muscle performance, and reported muscle symptoms were assessed at baseline and after exercise. Leukocyte CoQ10 was measured at baseline. RESULTS All muscle injury markers were comparable at baseline (P > 0.05) and increased following exercise (P < 0.001), with no differences in the magnitude of exercise-induced elevations among groups (P > 0.05). Muscle pain scores were higher at baseline in symptomatic statin users (P < 0.001) and increased similarly in all groups following exercise (P < 0.001). Muscle relaxation time increased more in symptomatic statin users than in control subjects following exercise (P = 0.035). CoQ10 levels did not differ among symptomatic (2.3 nmol/U; IQR: 1.8-2.9 nmol/U), asymptomatic statin users (2.1 nmol/U; IQR: 1.8-2.5 nmol/U), and control subjects (2.1 nmol/U; IQR: 1.8-2.3 nmol/U; P = 0.20), and did not relate to muscle injury markers, fatigue resistance, or reported muscle symptoms. CONCLUSIONS Statin use and the presence of statin-associated muscle symptoms does not exacerbate exercise-induced muscle injury after moderate exercise. Muscle injury markers were not related to leukocyte CoQ10 levels. (Exercise-induced Muscle Damage in Statin Users; NCT05011643).
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Allard et al. (2023) conducted an observational in Statin-associated muscle symptoms (n=100). Statin use (symptomatic and asymptomatic) vs. Nonstatin-using controls was evaluated on Magnitude of exercise-induced elevations in muscle injury markers (LDH, CK, myoglobin, cTnI, and NT-proBNP) among groups (p=>0.05). Statin use and the presence of statin-associated muscle symptoms did not exacerbate exercise-induced muscle injury after prolonged moderate-intensity exercise.
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