Statin and exercise prescription.

Peter Kokkinos and colleagues (Feb 2, p 394) describe the interactive eff ects of fi tness and statins on mortality risk in veterans with dyslipidaemia. They report that increasing physical activity and statins independently lowers lipid levels and total mortality, but that the combination of these interventions is superior to either alone. The authors conclude that prescription of physical activity is as important as prescribing statins in groups with increased cardiovascular risk. Physically active individuals might have the best cardiovascular risk profi le, but they might be more vulnerable to the skeletal muscle side-eff ects of statins. Sinzinger and O’Grady reported statin intolerance in elite soccer players, and the PRIMO study reported a higher incidence of statin induced myalgia in subjects performing intense sports. We have reported previously that statins magnify the increase in serum creatine kinase produced by exercise. Consequently physicians must weight relative benefi ts of physical activity and statins in active individuals. Physical activity could produce greater risk reduction than statins. The signifi cant eff ect of physical activity and statins on cardiovascular risk reduction emphasises the importance of determination of the causes and treatment of statin-induced myopathy, and the need for lipidlowering agents that do not aff ect skeletal muscle.