We measured the serum levels of myoglobin, total creatine kinase (CK), and the CK myocardial (CK-MB), muscle (CK-MM), and brain (CK-BB) isoenzymes in 37 subjects treated with statins and 43 nonstatin-treated controls running the 2011 Boston Marathon. Venous blood samples were obtained the day before (PRE) and within 1 hour (FINISH) and 24 hours after (POST) the race. The hematocrit and hemoglobin values were used to adjust for changes in the plasma volume. The CK distribution was normalized using log transformation before analysis. The exercise-related increase in CK 24 hours after exercise, adjusted for changes in plasma volume, was greater in the statin users (PRE to POST 133 ± 15 to 1,104 ± 150 U/L) than in the controls (PRE to POST 125 ± 12 to 813 ± 137 U/L; p = 0.03 for comparison). The increase in CK-MB 24 hours after exercise was also greater in the statin users (PRE to POST 1.1 ± 3.9 to 8.9 ± 7.0 U/L) than in the controls (PRE to POST 0.0 ± 0.0 to 4.2 ± 5.0 U/L; p <0.05 for comparison). However, the increases in muscle myoglobin did not differ at any point between the 2 groups. Increases in CK at both FINISH and POST race measurements were directly related to age in the statin users (r(2) = 0.13 and r(2) = 0.14, respectively; p <0.05) but not in the controls (r(2) = 0.02 and r(2) = 0.00, respectively; p >0.42), suggesting that susceptibility to exercise-induced muscle injury with statins increases with age. In conclusion, our results show that statins increase exercise-related muscle injury.
study at the Boston Marathon found that statins appear to be associated with increased
skeletal muscle injury, as evidenced by greater CK elevations in statin users (n =
37) compared to non-statin users (n = 40). However, the authors reported that
instead of seeing a drug dose-dependent increase in risk, susceptibility to greater CK
elevation appeared to be related to increasing age.70 Conditions that increase predisposition for statin-induced
myopathy are listed in Table 3. "
[Show abstract][Hide abstract] ABSTRACT: Statins have demonstrated substantial benefits in supporting cardiovascular health. Older
individuals are more likely to experience the well-known muscle-related side effects of
statins compared with younger individuals. Elderly females may be especially vulnerable to
statin-related muscle disorder. This review will collate and discuss statin-related
muscular effects, examine their molecular and genetic basis, and how these apply
specifically to elderly women. Developing strategies to reduce the incidence of
statin-induced myopathy in older adult women could contribute to a significant reduction
in the overall incidence of statin-induced muscle disorder in this vulnerable group of
patients. Reducing statin-related muscle disorder would likely improve overall patient
compliance, thereby leading to an increase in improved short- and long-term outcomes
associated with appropriate use of statins.
"What then may be the reason for the observed increase in WBC levels following exercise in this patient? Creatine kinase, another indirect marker of muscle damage is significantly elevated in statin users following exercise when compared to non-statin users . Urso et al.  have hypothesized that statin therapy may negatively affect the stability of skeletal muscle cell membranes. "
[Show abstract][Hide abstract] ABSTRACT: In a bid to reduce the morbidity and mortality associated with coronary artery disease, statin therapy has become a cornerstone treatment for patients with dyslipideamia. Statins, or HMG-CoA reductase inhibitors, are effective in blocking hepatic synthesis of cholesterol and are generally regarded as safe. Although rare, severe adverse side effects such as rhabdomyolysis have been reported, however, the more common complaint from patients is that related to myopathy. There is also mounting evidence that exercise may exacerbate these side effects, however the mechanisms are yet to be fully defined and there is controversy regarding the role that inflammation may play in the myopathy. This paper reports a patients experience during 6 months of simvastatin therapy and provides some insight into the white cell count (inflammation) following two bouts of moderate intensity exercise before and during statin therapy. It also highlights the need for rehabilitation practitioners to be aware of the adverse effects of statins in exercising patients.
Lipids in Health and Disease 03/2012; 11(1):40. DOI:10.1186/1476-511X-11-40 · 2.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The National Lipid Association's Muscle Safety Expert Panel was charged with the duty of examining the definitions for statin-associated muscle adverse events, development of a clinical index to assess myalgia, and the use of diagnostic neuromuscular studies to investigate muscle adverse events. We provide guidance as to when a patient should be considered for referral to neuromuscular specialists and indications for the performance of a skeletal muscle biopsy. Based on this review of evidence, we developed an algorithm for the evaluation and treatment of patients who may be intolerant to statins as the result of adverse muscle events. The panel was composed of clinical cardiologists, clinical lipidologists, an exercise physiologist, and a neuromuscular specialist.
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