Cholesterol-lowering drugs called statins – medications such as Zocor, Crestor, Lipitor, and Pravachol – have been getting their share of bad publicity. Recent press reports have shown possible links between the use of statin drugs and the development of dementia and diabetes. If this were not enough, a new study published in the Journal of the American College of Cardiology has shown that the drug Zocor may actually impair the development of aerobic fitness associated with exercise.
To put this issue into context, we know that statin drugs are very effective in reducing the risk of heart attack, stroke, and death. The risk of these events can be reduced by about 30% using a statin drug, which is particularly important in people who already have heart disease. However, there is equally impressive data on the benefits of exercise in preventing future heart attacks, stroke and premature death. In fact, statistically speaking, a sedentary lifestyle poses the same risk of heart disease, stroke, and premature death as does having high cholesterol. Many studies have shown that improving your level of aerobic fitness can reduce your all-cause mortality by 30 to 40%. Exercise is indeed very powerful medicine.
For decades, doctors have been telling patients with heart disease or high cholesterol to take statin drugs and to engage in regular aerobic activity. We assumed that the benefits of doing these things together would be additive. But as is often the case in medicine, time reveals the downside of medications that were initially trumpeted as miracle drugs. The longer any drug is used the more likely it is that we will learn about its hidden side effects.
In this new study, researchers examined the improvements that resulted from a 3 month aerobic fitness program. All of the participants engaged in the same exercise program. However, half of the people in the study took the statin drug Zocor and half remained off the drug. All of the participants were sedentary prior to starting the program and all were overweight or obese – just the kind of people we would typically advise to take statins.
After 12 weeks of exercise, those people who did not take Zocor improved their aerobic fitness by 10%. A nice result over a short period of time. By comparison, those patients who both exercised and took Zocor improved their aerobic fitness by only 1.5%! This is a dramatic reduction in the normal training response to exercise. One could argue that improving your fitness level by 1.5% is insignificant and hardly worth the effort of 3 months in the gym.
Taking Zocor was also associated with changes in the function of small cellular components called mitochondria, which are the powerhouses of the cell. Mitochondria are the organelles that produce ATP, the major energy currency during exercise. This finding is consistent with other studies that have shown microscopic changes on muscle biopsies taken from people who are taking statin drugs, even in people who had no symptoms of muscle soreness or weakness.
Does this mean that everyone should stop taking their statin drug? No. Many people who are at high-risk of suffering a heart attack, stroke or premature death should continue with their statin drugs at this time. However, we have not yet heard the end of this story. This study will no doubt trigger more research, which will likely change the way that doctors use these drugs over time. In the future, doctors will need to take a more individualized approach to prescribing statin drugs. For example, if a person has a high cholesterol level but wants to be very active and prefers to address his/her health risks by exercising more and losing weight, that may be preferable to taking drugs. For those people who cannot or will not exercise more, statins might be the best option – at least until more data becomes available.
If you are on a statin drug and have concerns about the findings of this study, feel free to make an appointment with me to discuss the best plan for you. However, the results of this study fall under the proverbial category of no such thing as a free lunch. As far as prescription drugs are concerned, there is often a price to pay for the benefits of the medication.