Although the use of statins and
the benefits of exercise are commonly discussed with patients with hyperlipidaemia;
up until now the topic of combining exercise with statins had not been fully
investigated. Now, a large-scale study claims that moderate exercise, such as
brisk walking 150 minutes per week, can lower the mortality risk substantially
among individuals with hyperlipidaemia.
The prospective cohort study,
which was published in The Lancet,
included a total of 10,043 participants from Veteran Affairs Medical Centers in
the US. The average age of the participants was 58, and within the sample 5046
were statin users, and 4997 were not statin users. During the first assessment,
the participants took part in a standard physical test where it was required
that they run on a treadmill until they felt exhausted. By inserting the peak
exercise time and peak speed into an equation, the researchers were able to
estimate so-called MET (metabolic equivalents) values for exercise. Based on
these values, participants were split into four groups according to fitness
level. They were then further divided each group into statin and non-statin
users. The participants were followed up ten years later to analyse whether
exercise (in combination with statins or on its own) decreases mortality. The
key results indicated that individuals who used statins and were considered the
most fit had 70% lower mortality risk than the least fit participants within
this group. Among the non-statin users, the least fit individuals had an
increased mortality hazard of 35% whereas the fittest individuals had a 47%
reduction in hazard ratio. This led researchers to conclude that exercise
decreases mortality for all individuals, and that exercise may be a
particularly useful tool to use in combination with statins. Perhaps the most
important conclusion was that these findings were independent from other
clinical characteristics.
In addition to the large sample
and the long follow-up period, there are several aspects of the study that are
commendable within the analysis. Given that the sample was taken from Veteran
Centres, the researcher had access to medical history that enabled them to
consider confounding variables. Moreover, during the follow up the participants
who had died were excluded in a second analysis in order to ensure that the
results were more sensitive. It is worth mentioning that there was no data
regarding cardiovascular interventions and cardiovascular mortality, diet or
whether statin treatment interfered with exercise. However, these limitations
could be adequately addressed in a future clinical trial.
We are not surprised to hear
about these findings, as we have been advocates for exercise for a long time.
However, we are somewhat astonished at the extent moderate exercise appears to
be helpful in reducing mortality in patients who take statins. This robust
study clearly demonstrates how important it is to incorporate exercise into
everyday life and we hope the findings make a difference among individuals
whether they are prescribed statins or not.