Statins, exercise, and exercise training.

Statins are life-saving medications and so effective that some have suggested they be added to the drinking water to “fluorinate” the vascular bed against atherosclerotic disease. But statins, both in research models and clinically, can have deleterious effects on skeletal muscle. The most serious side effects are myositis and rhabdomyolysis manifested by marked elevations in creatine kinase and associated, in several studies, with variants in the hepatic organic anion transporter protein SLCO1B1 (1). These variations result in reduced statin hepatic uptake and expose more of the periphery and skeletal muscle to the drug. Rhabdomyolysis is extremely rare in the absence of concomitant medications such as gemfibrozil, cyclosporine, human immunodeficiency virus protease inhibitors, azole antifungals, and macrolide antibiotics that increase statin blood and muscle levels (2).