Statins Linked to Lower Physical Activity

Abstract

Initiating statin therapy in older men was associated with a modest but significant drop in physical activity, according findings from a large, observational study published online in JAMA Internal Medicine. In addition, older men who used statins showed lower activity levels and higher levels of sedentariness than did nonusers, for as long as they took the drugs. Although results of an observational study such as theirs cannot prove causality, it is likely that the statins’ well-known adverse effects of inducing muscle pain, myopathy, and muscular fatigue account for these differences, said David S.H. Lee, PharmD, PhD, of Oregon State University/Oregon Health and Science University, Portland, and his associates. To assess the relationship between statin use and physical activity, the investigators analyzed data from the MrOS (Osteoporotic Fractures in Men Study), an observational study of healthy aging involving men aged 65 years and older who resided in six geographic regions across the United States and were followed at intervals for roughly 7 years. Dr. Lee and his colleagues performed both a cross-sectional analysis involving 4,137 of the participants (mean age, 73 years) and a longitudinal analysis involving 3,039 of them. About 24% were statin users at baseline, 48% never used statins throughout the study period, and the remainder began using statins during the study. Activity level was measured subjectively, using the PASE (Physical Activity Scale for the Elderly), and objectively, using an accelerometer. Men who began using statins during the study showed a modest but significant decline of about 10% in physical activity, compared with those who never took statins. After the data were adjusted to account for possible confounders between users and nonusers, such as medical history, body mass index, and smoking status, it was found that statin users engaged in 9.6% fewer minutes of moderate physical activity and 9.0% fewer minutes of vigorous activity per day than nonusers did. They also engaged in sedentary behavior for 1% more minutes per day than men who didn't use statins. This equates to a mean decrease of approximately 151 minutes/week of walking and 37.8 minutes/week of more vigorous exercise, and an increase of 21.8 hours/week in sedentariness, for the statin users (JAMA Intern Med 2014;174[8]:1263-70). Given these findings and the fact that the literature does not support the benefit of statin therapy in older adults, clinicians and patients should carefully weigh the drugs’ potential harms and benefits, Dr. Lee and his associates said. “This study provides further reasons not to use statins in persons over 75 …. We have seen falls decrease in many older persons once statins are stopped,” said John Morley, MD, director of the division of geriatric medicine and Dammert Professor of Gerontology at the St. Louis University School of Medicine. “Exercise is always an excellent therapy for older persons. However, unless the person in post-acute care has had an MI [myocardial infarction] or stroke in the last 6 months, statins should be avoided,” he added. This study was funded by the Medical Research Foundation of Oregon; the MrOS study was supported by the National Institutes of Health. Dr. Lee and his associates reported no potential financial conflicts of interest.