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Key clinical point: Statin use in older men may have the consequence of reducing their physical activity.
Major finding: Statin users engaged in 9.6% fewer minutes of moderate physical activity and 9.0% fewer minutes of vigorous activity per day than did nonusers, as well as 1% more minutes per day of sedentary behavior, 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.
Data source: An observational study with both cross-sectional and longitudinal components, involving 4,137 U.S. men aged 65 years and older, of whom about one-fourth used statins throughout the 7-year study period.
Disclosures: 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.
The benefits of physical activity extend well beyond simple metabolic and cardiovascular outcomes, and include improvements in mood, cognition, sleep, bone health, and respiration; the preservation of physical function; resilience to injury, illness, or surgery; and lower rates of death from all causes. In comparison, the benefits of statin therapy for older men are less well established, said Dr. Beatrice Alexandra Golomb.
"Some might think that reduced activity in new statin users should be managed by urging [them] to exercise more," but this could prove harmful because exercise has been reported to promote statin-associated muscle injury. Moreover, women – who were not included in the study by Lee et al. – consistently show more muscle problems than do men related to statin use, as do patients with certain features of the metabolic syndrome and other risk factors for muscle damage. Urging more exercise along with statin use in these patients could be particularly harmful, she said.
Dr. Golomb is at the University of California, San Diego. She reported no potential conflicts of interest. These remarks were taken from her Invited Commentary accompanying Dr. Lee’s report (JAMA Intern. Med. 2014 June 9 [doi:10.1001/jamainternmed.2013.14543]).
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 June 9 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, Pharm.D., Ph.D., 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 June 9 [doi:10.1001/jamainternmed.2014.2266]).
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 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.
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